Portal track infiltration versus Interscalene brachial plexus block for Pain control following shoulder arthroscopy

Abstract Arthroscopic shoulder surgery is often associated with severe postoperative pain that can be difficult to manage without large-dose opioids 1 , 2 . Local anaesthetics can also be injected into joint spaces to provide analgesia during and after arthroscopic surgery [3] . The goal of the present study was to assess the efficacy of the portal track infiltration versus interscalene block on adequacy of pain control, and possible side effects. Methods Sixty patients of ASA I or II patients, presenting for arthroscopic subacromial decompression, were included in this comparative randomized study. Group I received preincisional 30 ml of bupivacaine 0.5% using spinal needle 22G at the site of insertion of the trocars, 10 ml at each trocars site. Group II received interscalene block using the same equal amount of 30 ml bupivacaine 0.5% at the start of the procedure before general anaesthesia using electric nerve stimulator. Visual analogue scale (VAS), time to first need of analgesia in each group, total amount of analgesia and the occurrence of side effects necessitating overnight hospital stay were recorded. Results There was significant reduction of heart rate and mean blood pressure in group II compared to group I from 15 min onwards. VAS readings were insignificant between the two groups in the first 9 h postoperatively. As regards the timing of first requirement of analgesics and total amount of analgesia required in the first 24 h, and the complications necessitating overnight stay, the readings were insignificant in both groups. Conclusion This denotes that pre-emptive analgesia offered using portal track infiltration not only gives equipotent analgesia to that of the interscalene, but lacks significant risks and can be easily to give by the surgeon.