Summary
Awake arthroscopic shoulder surgery with intraoperative explanations via a monitor under ISB anesthesia increased satisfaction and decreased intraoperative complications compared with those in the intraoperative sedation group.
Abstract
Introduction
Recently, the advantages of ultrasound-guided interscalene block (ISB) anesthesia for shoulder surgery have been reported. Arthroscopic shoulder surgeries using ISB are primarily performed using intraoperative sedation in our hospital. However, patients who desired to remain awake received no sedation and were given intraoperative explanations via a monitor. This study aimed to investigate perioperative complications and patient satisfaction after arthroscopic shoulder surgery under ISB with and without intraoperative patient sedation.
Materials And Methods
This study included 178 patients (94 and 84 in the awake and sedation groups, respectively) who underwent shoulder arthroscopy under ultrasound-guided ISB at Owase General Hospital in 2021–2024. The mean ages of the awake and sedation groups were 69.4 ± 11.6 and 70.4 ± 9.5, respectively. Both groups underwent rotator cuff repair, labrum repair, subacromial decompression, calcification removal, acromioclavicular joint arthroplasty, and arthrolysis. There was no significant differences in the average age, total anesthesia time, or operation times between the two groups. All ultrasound-guided ISB procedures were performed using 0.75% ropivacaine, which was injected around the C5–C7 nerve routes. Patients in the sedation group received an intravenous dexmedetomidine administration intraoperatively. All surgeries were performed in the beach chair position. The outcomes were assessed according to intraoperative complication incidences, defined as symptoms that required any emergency additional medication to recover, average satisfaction score (1: very dissatisfied, 2: dissatisfied, 3: fair, 4: satisfied, and 5: very satisfied), satisfaction rate (percentage of patients with reported the satisfaction scores > 4 points), and ISB anesthesia reselection rate in patients if another shoulder arthroscopy was necessary. The researchers collected the average satisfaction score, satisfaction rate, and ISB-reselection rate from a postoperative questionnaire. The questionnaire included two open questions: “What made you feel good?” and “What made you feel some discomfort?” in the operating room.
Results
The incidences of intraoperative complications were 4.3% and 14.3% (p = 0.033), the satisfaction scores were 4.45 ± 0.65 and 4.22 ± 0.72 points (p = 0.010), the average satisfaction rates were 95.7% and 83.3% (p = 0.011), and the ISB-reselection rate were 100% and 87.8% (p < 0.01) in the awake and sedation groups, respectively. Representative answers to open questions about something that made the awake group feel good included live commentary using a TV monitor (67.3%) and conversation with the surgeon during surgery (14.3%). In contrast, none in particular (57.1%) and difficulty in keeping the position (12.2%) caused them to feel discomfort. No limitations in eating and resting postoperatively (28.3%) and surgery completion without knowing (18.9%) made the sedation group feel good. In contrast, none in particular (45.3%) and anxiety about the effect of anesthesia (9.4%) caused them to feel discomfort.
Conclusion
The results revealed that awake arthroscopic shoulder surgery under ISB anesthesia increased satisfaction and decreased intraoperative complications compared with intraoperative sedation. Therefore, it is a practical option for patients who desire to remain awake and receive intraoperative explanation.