Subacromial Infusion Doesn’t Improve Pain Control

There are multiple options for pain control after shoulder arthroscopy, but new data suggests that subacromial infusion shouldn’t be one of them.

With more than 500,000 procedures performed each year, shoulder arthroscopy is one of the most common orthopedic procedures.

In their study, “Pain Control After Shoulder Arthroscopy: A Systematic Review of Randomized Controlled Trials With A Network Meta-analysis,” published online on December 15, 2020 in The American Journal of Sports Medicine, the researchers set out to determine what pain control options lead to the best patient outcomes.

They systematically reviewed randomized-controlled trials on pain control after shoulder arthroscopy in the acute postoperative setting using the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. The pain control interventions included in the studies were nerve blocks, nerve block adjuncts, subacromial injections, patient-controlled analgesia, and oral medications.

The systematic review analyzed 83 randomized-controlled trials. The researchers found that across 40 of the studies, peripheral nerve blocks significantly reduced postoperative pain and opioid use.

There was no significant difference, however, among the variable blocks in the network meta-analysis. They did find though that continuous interscalene block had the highest P-score at most time points.

Nerve block adjuncts were consistently successful at prolonging nerve block time and reducing time across 18 of the studies. And preoperative administration significantly reduced postoperative pain scores (p < .05).

The researchers, however, didn’t find any benefit to subacromial infusions where a mixture of anesthesia and anti-inflammatory medicine is injected into the space between the acromion and the head of the humerus.

They wrote, “Continuous interscalene block resulted in the lowest pain levels at most time points, although this was not significantly different when compared with the other nerve blocks. Additionally, nerve block adjuncts may prolong the postoperative block time and improve pain control.”

Adding that while “there is promising evidence for some oral medications and newer modalities to control pain and reduce opioid use,” they found “no evidence to support the use of subacromial infusions or patient-controlled analgesia.”