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Regarding “Postoperative Pain Control After Arthroscopic Rotator Cuff Repair: Arthroscopy-Guided Continuous Suprascapular Nerve Block Versus Ultrasound-Guided Continuous Interscalene Block”

      By a prospective, nonrandomized cohort study, Kim et al.
      • Kim H.
      • Kim H.J.
      • Lee E.S.
      • et al.
      postoperative pain control after arthroscopic rotator cuff repair: Arthroscopy-guided continuous suprascapular nerve block versus ultrasound-guided continuous interscalene block.
      compared the efficacy and safety of arthroscopy-guided continuous suprascapular nerve block (AS-SSNB) and ultrasound-guided continuous interscalene block (US-ISB) for postoperative pain control in patients undergoing arthroscopic rotator cuff repair. They showed that the AS-SSNB was not inferior to the US-ISB for postoperative analgesia and resulted in fewer temporary neurologic complications. A valuable clinical trial has been performed, but we noted several issues in methodology and results of this study that needed further clarification and discussion.
      First, both AS-SSNB and US-ISB were carried out before general anesthesia, but intraoperative opioid consumption was not provided and compared between groups. Thus, an important issue that was not answered in this study was whether both AS-SSNB and US-ISB could provide a comparable benefit of intraoperative opidiod-sparing. Most important, the readers were not provided the dosages of intraoperative opioid drugs and the timing of intraoperative opioid administration in relation to the assessment of early postoperative pain, although they can significantly affect assessment of early postoperative pain.
      Second, patients underwent arthroscopic rotator cuff repair, and the postoperative pain visual analog score (VAS) was assessed using a questionnaire. However, the readers were not provided the patient’s state when postoperative pain was assessed. In fact, an active state can significantly aggravate postoperative pain. Considering that postoperative pain VAS of patients in the 2 groups have large standard deviations, we are concerned that this unknown factor would have confused the results of postoperative pain assessement. Furthermore, it is generally believed that satisfied postoperative analgesia should achieve a VAS score of 3 or less.
      • Zhang Z.
      • Xu H.
      • Zhang Y.
      • et al.
      Nonsteroidal anti-inflammatory drugs for postoperative pain control after lumbar spine surgery: A meta-analysis of randomized controlled trials.
      We noted that means of postoperative pain VAS within 24 hours after surgery in the 2 groups were more than 3 or 4. These results indicate that a significant proportion of patients receiving the AS-SSNB and US-ISB still experience moderate to severe pain in early postoperative period.
      • Chen H.
      • Luo A.
      Safety and efficacy study of the cyclooxygenase-2 inhibitor parecoxib sodium applied for postoperative analgesia after endo-nasal operation.
      Thus, we argue that this study does not provide the robust evidence that both the AS-SSNB and US-ISB are effective techniques of postoperative pain control for arthroscopic rotator cuff repair.
      Finally, this study observed sensory or motor function changes of peripheral nerves at the affected side and the occurrence of adverse events associated with nerve blocks, such as dyspnea, dysphonia, Horner’s syndrome, nausea or vomiting, and hemidiaphragmatic paresis. However, the quality of postoperative recovery and patients’ satisfaction with postoperative analgesia were not assessed. In fact, these variables are very important for determining the efficacy and clinical availability of an intervention and are easily measured using by a QoR-15 score ranging from 0 to 150 (a higher score indicating an improved quality of postoperative recovery)
      • Stark P.A.
      • Myles P.S.
      • Burke J.A.
      Development and psychometric evaluation of a postoperative quality of recovery score: The QoR-15.
      and a VAS (0 = least satisfied, 100 = most satisfied),
      • Li Q.
      • Hu Q.
      • Alqwbani M.
      • Li D.
      • Yang Z.
      • Wang Q.
      • Kang P.
      Additional nerve blocks are not superior to multiple-site infiltration analgesia in total knee arthroplasty under adductor canal block.
      respectively. We believe that this study would have provided more useful data about the clinical values of AS-SSNB and US-ISB for postoperative analgesia in patients with arthroscopic rotator cuff repair, if the design had included the assessments of these 2 variables.

      Supplementary Data

      References

        • Kim H.
        • Kim H.J.
        • Lee E.S.
        • et al.
        postoperative pain control after arthroscopic rotator cuff repair: Arthroscopy-guided continuous suprascapular nerve block versus ultrasound-guided continuous interscalene block.
        Arthroscopy. 2021; 37: 3229-3237
        • Zhang Z.
        • Xu H.
        • Zhang Y.
        • et al.
        Nonsteroidal anti-inflammatory drugs for postoperative pain control after lumbar spine surgery: A meta-analysis of randomized controlled trials.
        J Clin Anesth. 2017; 43: 84-89
        • Chen H.
        • Luo A.
        Safety and efficacy study of the cyclooxygenase-2 inhibitor parecoxib sodium applied for postoperative analgesia after endo-nasal operation.
        Pain Pract. 2016; 16: 467-472
        • Stark P.A.
        • Myles P.S.
        • Burke J.A.
        Development and psychometric evaluation of a postoperative quality of recovery score: The QoR-15.
        Anesthesiology. 2013; 118: 1332-1340
        • Li Q.
        • Hu Q.
        • Alqwbani M.
        • Li D.
        • Yang Z.
        • Wang Q.
        • Kang P.
        Additional nerve blocks are not superior to multiple-site infiltration analgesia in total knee arthroplasty under adductor canal block.
        J Orthop Surg Res. 2021; 16: 591

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