Conclusion There are many risk factors associated with developing an infection after elective shoulder surgery .
The findings of this systematic review are clinical ly relevant as it has been shown that infection after shoulder surgery results in poor patient-reported outcomes and pose a significant financial burden .
Purpose Infection is a concern after all orthopedic procedures , including shoulder surgery .
This systematic review of literature aim ed to determine risk factors for infection as well as the availability and effectiveness of measures utilized to prevent infection after elective shoulder surgery .
Evaluation of the Lateral Modified Approach for Continuous Interscalene Block after Shoulder Surgery
Background Continuous interscalene block is the technique of choice for postoperative pain relief treatment after shoulder surgery . The authors prospect ively evaluated the modified lateral approach for the performance of the interscalene catheter block and monitored 700 patients for clinical efficacy and complications during the first 6 months after placement of the catheter . Methods A total of 700 adults scheduled to undergo elective shoulder surgery performed with an interscalene brachial plexus block through an interscalene catheter were included in this study . The interscalene brachial plexus block procedure was st and ardized for all patients . Difficulties in placement of the catheter , clinical efficacy of anesthesia and analgesia , patient satisfaction , and acute and chronic complications were recorded . Patients were observed daily for 5 days for any complications and were evaluated at 1 , 3 , and 6 months after surgery . Persistence of neurologic complication was investigated by electroneuromyography . Results A total of 700 adults completed the study . Easy placement of the catheter ( one attempt ) was achieved in 86 % of the patients . Resistance to thread the catheter was encountered in 6 % ; no major complications were observed during injection of the initial bolus . The success rate for anesthesia was 97 % . Postoperative analgesia was efficient in 99 % . The concentration and the rate of infusion of ropivacaine  had to be increased in 31 patients ( 6 % ) . In five patients ( 0.7 % ) , signs of local infection around the puncture point were noted ; in one patient ( 0.1 % ) , a collection of pus was surgically drained . Patient satisfaction was 9.6 on a scale of 0–10 . Minor neurologic complications ( paresthesias , dysesthesias , pain not related to surgery ) were observed in 2.4 % , 0.3 % , and 0 % at 1 , 3 , and 6 months , respectively . At 1 month , three sulcus ulnaris syndromes , one carpal tunnel syndrome , and one complex regional pain syndrome were diagnosed . Two patients ( 0.2 % ) had sensory-motor deficit , which necessitated 19 and 28 weeks to recover . Electromyography was suggestive of partial axonotmesis . Conclusion The lateral modified approach provides good conditions for placement of the interscalene catheter . Anesthesia and analgesia performed through the catheter are efficient . The rates of infection and neurologic complications are low , and patient satisfaction is high
Conclusion There are many risk factors associated with developing an infection after elective shoulder surgery .
The findings of this systematic review are clinical ly relevant as it has been shown that infection after shoulder surgery results in poor patient-reported outcomes and pose a significant financial burden .
Purpose Infection is a concern after all orthopedic procedures , including shoulder surgery .
This systematic review of literature aim ed to determine risk factors for infection as well as the availability and effectiveness of measures utilized to prevent infection after elective shoulder surgery .