Post-operative pain control using a comprehensive programme for day-case shoulder surgery

There is a common belief that shoulder surgery is very painful afterwards. This should not be the case and most shoulder operations can be perfromed as day-cases. We previously published our results using our comprehensive pain control regimen. With the introduction of ultrasound guided interscalene blocks and new cold compression wraps we reviewed our current results and were pleased to see that the results were even better with this. Study abstract below:

 ABSTRACT

Emma Torrance, Linda Hallam, Bhagwant Hundle & Lennard Funk 
Performed at The Wilmslow Hospital 52  Alderley Road

Background: Development in both arthroscopic techniques and pain relief have facilitated the transition from in-patient to day-case shoulder surgery. Despite this, there are still concerns in the community regarding pain management from day-case surgery.

Aims: We aim to assess the adequacy of peri-operative pain control for day-case shoulder surgery, with particular emphasis on pain once the interscalene block has subsided.
Methods: 118 patients were reviewed retrospectively regarding their postoperative pain following day-case shoulder surgery. The programme included pre-operative patient information (written and verbal) on listing and admission; interscalene block; intra-operative intravenous paracetamol, steroids, antiemetic and non-steroidal antiinflammatory (NSAID); post-operative cold compression wrap; post-operative oral paracetamol, codeine and NSAID, with Tramadol for break-through pain and a 24 hour follow-up phone call. The patient cohort consisted of 84 males and 34 females; with a mean age of 41.28 ± 15.34 (range 16 -77). Patients were followed up by telephone, 24 hours following surgery, by the practice surgical practitioner. Questions were posed regarding current pain and analgesics.

Results: Sixty-five per cent of patients described none or mildly painful symptoms 24 hours postoperatively, with 34.8% of patients experiencing moderate pain. No patient described severe pain within 24 hours following surgery. No significant differences were notable between patient gender (p=0.2250), age (p=0.190), preoperative pain (p=0.112), sporting activities (p=0.1546) and severity of postoperative pain.

Conclusion: Postoperative pain after day-case shoulder surgery can be effectively managed with a comprehensive analgesic regimen. This includes open shoulder surgery and complex arthroscopic procedures
Keywords: Peri-operative pain, shoulder surgery, cold compression therapy, interscalene block, day-case surgery