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Postoperative Delirium after Reverse Total Shoulder Arthroplasty: Interscalene Block Versus General Anesthesia.
Sung Min Rhee1, Soo Young Kim2, Cheol Hwan Kim2
1Shoulder and Elbow Clinic, Department of Orthopedic Surgery, College of Medicine, Kyung Hee University Hospital, Seoul, Korea.
Clinics in Orthopedic Surgery
|April 2, 2025
Summary
Interscalene block (IB) anesthesia is a better choice than general anesthesia (GA) for elderly patients undergoing reverse total shoulder arthroplasty (rTSA). IB reduces postoperative delirium (PD) and pain compared to GA.
Area of Science:
- Orthopedic Surgery
- Anesthesiology
- Geriatric Medicine
Background:
- Postoperative delirium (PD) is a significant concern in elderly patients undergoing major orthopedic procedures.
- Reverse total shoulder arthroplasty (rTSA) for irreparable massive rotator cuff tears (mRCTs) is increasingly common in the geriatric population.
- Anesthetic technique may influence the incidence and severity of PD.
Purpose of the Study:
- To compare the severity of postoperative delirium (PD) in elderly patients undergoing rTSA for mRCTs.
- To evaluate the impact of general anesthesia (GA) versus interscalene block (IB) on PD.
- To assess postoperative pain levels associated with each anesthetic technique.
Main Methods:
- Prospective case-controlled study involving 40 elderly patients (≥65 years) undergoing rTSA for mRCTs.
- Patients were divided into two groups: 20 under GA and 20 under IB.
- Delirium severity was assessed using the Delirium Rating Scale-revised-98 (DRS) at multiple postoperative time points.
Main Results:
- The interscalene block (IB) group experienced significantly less pain immediately after surgery compared to the general anesthesia (GA) group (VAS difference: 3.80 vs. 6.25).
- While not statistically significant on initial days, the mean change in DRS scores from baseline was significantly lower in the IB group (1.30) versus the GA group (4.15) (p=0.014).
- The GA group showed a peak in DRS scores on postoperative day 3, whereas the IB group's peak occurred on postoperative day 0.
Conclusions:
- Interscalene block (IB) is an effective anesthetic option for reducing postoperative delirium in elderly patients undergoing rTSA.
- IB anesthesia is associated with lower delirium severity and reduced postoperative pain compared to general anesthesia (GA).
- Anesthetic choice plays a crucial role in managing postoperative outcomes for elderly patients undergoing shoulder arthroplasty.
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