Ramesh Kiran, Yusuf Muhammad, Makaram Navnit, Milton Ross, Mathew Aji, Srinivasan Makaram
Orthopedics and Traumatology, Wirral Teaching Hospitals NHS Trust, Wirral, GBR.
Orthopedics and Traumatology, Pennine Acute Hospitals NHS Trust, Manchester, GBR.
Cureus. 2021 Mar 25;13(3):e14106. doi: 10.7759/cureus.14106.
Aims To investigate the safety and cost-effectiveness of interscalene brachial plexus block/regional anaesthesia (ISB-RA) in patients undergoing reverse total shoulder replacement. Patients and methods This retrospective study included 15 patients with symptomatic rotator cuff arthropathy who underwent reverse total shoulder arthroplasty (rTSA) under ISB-RA without general anaesthesia in the beach chair position from 2010 to 2018. The mean patient age was 77 years (range 59-82 years). Patients had associated medical comorbidities: American Society of Anesthesiologists (ASA) grade 2-4. Assessed parameters were: duration of anaesthesia, intra-operative systolic blood pressure variation, sedation and vasopressor use, duration of post-operative recovery, recovery scores, length of stay, and complications. A robust cost analysis was also performed. Results The mean (range) duration of anaesthesia was 38.66 (20-60) min. Maximum and minimum intra-operative systolic blood pressure ranges were 130-210 and 75-145 mmHg, respectively (mean [range] drop, 74.13 [33-125] mmHg). Mean (range) propofol dose was 1.74 (1-3.0) mg/kg/h. The Median (interquartile range) post-operative recovery time was 30 (20-50) min. The mean (range) postoperative recovery score (local scale, range 5-28 where lower values are superior) was 5.2 (5-8). The mean (range) length of stay was 8 (1-20 days); the two included patients with ASA grade 2 were both discharged within 24 hours. One patient with predisposing history developed pneumonia; however, there were no complications related to ISB-RA. The mean (range) cost per patient was £101.36 (£59.80-£132.20). Conclusions Our data demonstrate that rTSA under ISB-RA is safe, comfortable, and cost-effective. Notably, patients with ASA grade 2 who underwent rTSA under ISB-RA had a reduced length of stay and were discharged within 24 hours. Clinical relevance rTSA under ISB-RA is potentially a safe, cost-effective, and viable alternative for patients with multiple comorbidities.
目的 探讨肌间沟臂丛神经阻滞/区域麻醉（ISB-RA）用于接受反式全肩关节置换术患者的安全性和成本效益。
患者与方法 这项回顾性研究纳入了15例有症状的肩袖关节病患者，他们于2010年至2018年在沙滩椅体位下接受了在ISB-RA下而非全身麻醉的反式全肩关节置换术（rTSA）。患者平均年龄为77岁（范围59 - 82岁）。患者伴有相关内科合并症：美国麻醉医师协会（ASA）分级为2 - 4级。评估参数包括：麻醉持续时间、术中收缩压变化、镇静及血管升压药使用情况、术后恢复时间、恢复评分、住院时间及并发症。还进行了全面的成本分析。
结果 平均（范围）麻醉持续时间为38.66（20 - 60）分钟。术中收缩压最高和最低范围分别为130 - 210 mmHg和75 - 145 mmHg（平均[范围]下降74.13 [33 - 125] mmHg）。平均（范围）丙泊酚剂量为1.74（1 - 3.0）mg/kg/h。术后恢复时间的中位数（四分位间距）为30（20 - 50）分钟。术后恢复评分的平均（范围）值（局部量表，范围5 - 28，分值越低越好）为5.2（5 - 8）。平均（范围）住院时间为8（1 - 20）天；两名ASA 2级患者均在24小时内出院。一名有易感病史的患者发生了肺炎；然而，没有与ISB-RA相关的并发症。每位患者的平均（范围）成本为101.36英镑（59.80 - 132.20英镑）。
结论 我们的数据表明，在ISB-RA下进行rTSA是安全、舒适且具有成本效益的。值得注意的是，在ISB-RA下接受rTSA的ASA 2级患者住院时间缩短且在24小时内出院。
临床意义 在ISB-RA下进行rTSA对于有多种合并症的患者可能是一种安全、具有成本效益且可行的替代方案。
