Patient survey of continuous interscalene analgesia at home after shoulder surgery: 57.

Background: The use of continuous peripheral nerve blocks at home (CPNBH) has improved patients’ perioperative experience. In 30 months, 348 patients were sent home with interscalene CPNBH. Methods: With the Institutional Review Board (IRB) approval, all patients were surveyed for quality of analgesia and complications. The patients and their caretaker received verbal and written instructions, including care of the catheter and pump, and a list of complications and side effects. All were instructed on catheter removal and were given a contact number, and patients were called once per day. Results: 172 patients responded to this survey. The majority of patients (76%) had very good postoperative analgesia. There was a 9.3% incidence of leakage of clear fluid, a 5.8% incidence of premature dislodgement, and an 8.7% incidence of shortness of breath. Residual neurological symptoms persisted in 18.6% of responders, all resolving within two months except in one case. A large proportion (40%) required no oral analgesics, and half of the rest required less than 3 pain pills. Most (94.1%) felt comfortable removing the catheters at home by themselves or by a family member/caretaker. Conclusion: This survey shows that CPNBH results in low pain scores and a low incidence of side effects. Many patients commented positively on their overall impression of their anesthesia care, particularly the level of attention that they received. This highlights the low incidence of those complications and neural injury. From Wayne State University, Detroit, Michigan, USA. * MD, Assistant Professor of Anesthesiology. ** MD, Anesthesiology Resident. *** MD, Associate Professor of Orthopedics. Correspondence: Roland Kaddoum, MD, Department of Anesthesiology, 3990 John R, Box 162, Detroit, MI 48201. Phone: 313 745 7233, Fax: 313 993 3889. E-mail: rolandkaddoum@yahoo.com Financial support: Support was provided in part by the I-Flow Corporation, Lake Forest, CA and by the Department of Anesthesiology, Wayne State University, Detroit, MI. 214 ELIE J CHIDIAC ET. AL Table 2 Types of surgeries Types of surgeries Total CPnB1 Survey responses Open musculotendinous repairs 86 33 Shoulder arthroplasties 78 37 Open shoulder capsular repairs 39 26 Arthroscopic surgeries 148 65 Shoulder manipulation under anesthesia 27 11 1 continuous peripheral nerve blocks. Most were sent home with CPNBH (Table 3) and 30 were removed prior to discharge (Table 4). All 348 patients who went home with CPNBH were included in this study. Table 3 Outcome after surgery Home on day-of-surgery with CPNBH1: 147 Home on POD#12 with CPNBH: 103 Home on PO#23 with CPNBH: 98 Catheter removed in-hospital prior to discharge: 30 1 continuous peripheral nerve blocks at home. 2 Post operative day one. 3 Post operative day two. Table 4 Catheters removed prior to discharge Ineffective pain relief: 9 Catheter inadvertently dislodged: 2 Excessive fluid leakage: 4 No pain with CPNB turned off: 4 Redness at site: 2 In-hospital till POD#31, so catheter removed as planned: 3 Shortness of breath: 4 Disliked feeling of numb hand: 2 1 Post operative day three. After pre-procedure instructions to the patient in the presence of their family member/ caretaker, patients were taken into a ‘block room’. With noninvasive monitoring and after intravenous sedation, all interscalene catheters were placed using the modified lateral approach6,7. Stimulating catheters (Stimucath®, Arrow International, Reading, PA) were used for all cases. No solution was injected through the needle. All catheters were threaded 4-5 cm beyond the needle tip with continuous stimulation and tunneled subcutaneously toward the midline. Just before securing the catheters, the patient’s family member/caretaker was brought into the ‘block room’, Introduction Placement of continuous catheters near peripheral nerves for postoperative pain control has been shown to increase patient satisfaction1, decrease narcotic requirements and resultant nausea and vomiting2, improve quality of sleep2, accelerate the rehabilitation process3, and decrease hospital costs4. At the Michigan Orthopaedic Specialty Hospital, over 700 patients have been discharged with continuous peripheral nerve blocks at home (CPNBH). The majority have been those undergoing shoulder surgery and receiving a continuous brachial plexus catheter via an interscalene approach. There is one article in the literature, based on a telephone survey reviewing CPNBH from the patients’ perspective, with 131 patients5. Of those, only 22 had interscalene catheters. The purpose of this retrospective study was to gather data on a larger patient sample and evaluate the quality of pain control and the frequency of side effects, particularly pulmonary, neurological and infectious complications. Materials and Methods With approval from Wayne State University’s Institutional Review Board, all patients were mailed a letter and consent explaining the survey. Two weeks later, all were mailed a questionnaire (Table 1). Table 1 Survey Questions 1 How well was your pain controlled during the continuous infusion? 2 Where there any catheter problems? 3 Was there any infection, pus or drainage? 4 Did you have any difficulty breathing? 5 Did you have any residual numbness or tingling after catheter removal? If yes, for how long? 6 How many pain pills did you take while the catheter was in place? 7 When was the catheter removed? 8 Did you feel comfortable removing the catheter at home? 9 Would you recommend this technique? 10 Rate your overall satisfaction. Between March 2003 and August 2005 (30 months), 378 interscalene catheters were inserted for various shoulder procedures (Table 2).