Reducing rebound pain severity after arthroscopic shoulder surgery under general anesthesia and interscalene block: a two-centre randomized controlled trial of pre-emptive opioid treatment compared with placebo.

Autor: Uppal V; Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada. v.uppal@dal.ca.; Nova Scotia Health Authority, Halifax, NS, Canada. v.uppal@dal.ca.; IWK Health Centre, Halifax, NS, B3H 2Y9, Canada. v.uppal@dal.ca., Barry G; Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.; Nova Scotia Health Authority, Halifax, NS, Canada.; IWK Health Centre, Halifax, NS, Canada., Ke JXC; Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.; Nova Scotia Health Authority, Halifax, NS, Canada.; IWK Health Centre, Halifax, NS, Canada.; Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada.; Department of Anesthesia, St. Paul's Hospital/Providence Health Care, Vancouver, BC, Canada., Kwofie MK; Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.; Nova Scotia Health Authority, Halifax, NS, Canada.; IWK Health Centre, Halifax, NS, Canada., Trenholm A; Nova Scotia Health Authority, Halifax, NS, Canada.; Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada., Khan M; Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada., Shephard A; Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada., Retter S; Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.; Nova Scotia Health Authority, Halifax, NS, Canada.; IWK Health Centre, Halifax, NS, Canada., Shanthanna H; Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
Jazyk: angličtina
Zdroj: Canadian journal of anaesthesia = Journal canadien d'anesthesie [Can J Anaesth] 2024 Jun; Vol. 71 (6), pp. 773-783. Date of Electronic Publication: 2023 Oct 13.
DOI: 10.1007/s12630-023-02594-0
Abstrakt: Purpose: Although a single-injection interscalene block provides effective early postoperative analgesia following shoulder surgery, patients may experience "rebound pain" when the block resolves. Our objective was to determine if oral hydromorphone (2 mg) given six hours after a single-injection interscalene block for arthroscopic shoulder surgery leads to a clinically significant reduction in the severity of rebound pain.
Methods: After approval from research ethics boards, we conducted a two-centre, parallel-group, double-blind, randomized, placebo-controlled superiority trial. Patients received preoperative interscalene block, general anesthesia, and either hydromorphone or placebo six hours after the block. The primary outcome was the worst pain score in the first 24 hr postoperatively, measured on an 11-point (0-10) numerical rating scale.
Results: A total of 73 participants were randomly assigned to either the hydromorphone or placebo group. There was no statistically significant difference in the mean (standard deviation) worst pain score within 24 hr between the hydromorphone and placebo groups (6.5 [2.4] vs 5.9 [2.3]; mean difference, 0.6; 95% confidence interval, -0.5 to 1.8). Similarly, we did not find any significant difference in the pain trajectory, opioid use, or incidence of nausea and vomiting between the groups. The mean time to worst pain was 14.6 hr, and the mean time to first rescue analgesia was 11.3 hr after interscalene block.
Conclusion: Hydromorphone 2 mg given six hours after interscalene block did not reduce the severity of rebound pain postoperatively compared with placebo in patients undergoing arthroscopic shoulder surgery.
Study Registration: ClinicalTrials.gov (NCT02939209); registered 19 October 2016.
(© 2023. Canadian Anesthesiologists' Society.)
Databáze: MEDLINE
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