2025 ISAKOS Biennial Congress ePoster
Adding an Erector Spinae Plane Catheter Block AfteraAn Interscalene Nerve Block Significantly Improves Pain Relief and Decreases Opioid Use Following Arthroscopic Rotator Cuff Repair
Chih-Kai Hong, MD, Tainan City TAIWAN
Wei-Kuo Hsu, MD, Tainan City, Others TAIWAN
Shu-Cheng Liu, MD, Tainan TAIWAN
Chi-Hsiu Wang , B.S., MSc, Tainan TAIWAN
Hao-Chun Chuang, MD TAIWAN
Fachuan Kuan, MD, PhD, Tainan, Taiwan TAIWAN
Kai-Lan Hsu, MD, Tainan TAIWAN
Wei-Ren Su, MD, MSc, Tainan TAIWAN
National Cheng Kung University Hospital, Tainan, TAIWAN
FDA Status Not Applicable
Summary
Additional catheterization for ESP block reduced postoperative pain, opioid consumption, and opioid-related side effects during the acute postoperative period of arthroscopic rotator cuff repair when ISNB and multimodal oral analgesics had already been administered.
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Abstract
Background
The effects of the erector spinae plane (ESP) block and interscalene nerve block (ISNB) on arthroscopic rotator cuff repair (RCR) have been investigated separately.
Purpose
To evaluate whether additional catheterization for ESP block decreases acute postoperative pain and opioid consumption in patients undergoing arthroscopic RCR when ISNB and multimodal oral analgesics have already been given.
Study Design: Cohort study; Level of evidence, 3.
Methods
The retrospective study included patients undergoing primary arthroscopic RCR who received either ISNB or additional ESP block catheterization as part of their pain management between January 1 and December 31, 2021, in our medical center by a single surgeon. Patients who underwent concomitant shoulder procedures were excluded. Patient demographics, surgical details, selected pain control protocols, preoperative and postoperative numerical pain rating score (NRS), rescue analgesic use, and possible opioid-related side effects were recorded. The primary outcome was the postoperative NRS at 9 PM following surgery; secondary outcomes included the rescue opioid use and possible opioid-related side effects (nausea and vomiting, headache, dizziness, and urinary retention) until patients were discharged the next day. Mann-Whitney U test or chi-squared analysis was used for between group comparison. Factors were examined for their contributions to the total morphine dosage in a multiple linear regression model.
Results
Fifty-four patients were included: 21 underwent the ISNB protocol and 33 underwent additional ESP catheterization protocol. The additional ESP group exhibited significantly lower postoperative NRS (3.0 ± 1.6 vs 2.0 ± 0.3, p= 0.003), reduced morphine milligram-equivalent (MME) consumption during hospitalization (6.1 ± 8.3 vs 0.5 ± 1.3, p< 0.001), and fewer morphine-related side effects (3 vs 0, p= 0.022). Multiple linear regression analysis suggested that the ISNB protocol (ß = 5.750, p< 0.001) and the number of anchors used in surgery (ß = 1.609, p= 0.022) were independently correlated with higher opioid consumption. Subanalysis revealed additional ESP block significantly reduced MME (7.6 ± 9.0 vs 0.5 ± 1.4, p< 0.001) during repairs involving two or more tendons.
Conclusions
Our retrospective study demonstrates that additional catheterization for ESP block reduced postoperative pain, opioid consumption, and opioid-related side effects during the acute postoperative period of arthroscopic RCR when ISNB and multimodal oral analgesics had already been administered. Future studies to evaluate this treatment protocol are needed to further assess pain relief after arthroscopic RCR surgery.