Comparison of interscalene block, general anesthesia, and intravenous analgesia for out-patient shoulder reduction.

ABSTRACT

PURPOSE: Shoulder dislocation is often associated with intense pain, and requires urgent pain therapy and reduction. Interscalene block, general anesthesia, or intravenous analgesia alone are applied procedures that facilitate shoulder reduction by the surgeon and ease patients' pain. This study was conducted to compare procedure times, patient satisfaction, side-effects, and clinical outcome of these clinical procedures. METHODS: Retrospective chart analysis was performed for all patients treated at the Emergency Department of a primary care hospital. In addition, standardized telephone interviews were conducted. Subjective clinical outcome and patient satisfaction (SF-36, Quick-DASH, ZUF-8) were measured with the standardized questionnaires. RESULTS: The shortest overall procedure time [67.5 min (48.8-93.5 min), P = 0.003] was found in patients with interscalene block. The advantage of general anesthesia was the shortest anesthesia induction time [10 min (7.8-10 min), P < 0.0001]; reduction time [6 min (4.3-6 min), P = 0.039]; and time to discharge [90 min (67.5-123.8 min), P = 0.0001] were significantly prolonged in comparison to interscalene block [5 min (1-5 min) and 45 min (2-67.5 min)]. The longest reduction time [11 min (10-13.5 min), P = 0.0008] was seen in patients in the intravenous analgesia group. Overall, patient satisfaction was greater in patients with regional as compared to general anesthesia [measured by ZUF-8 12 (9-15) vs. 17 (12-24), P = 0.03]. Subjective clinical outcome (SF-36, DASH) was comparable among the three groups. There was one immediately identified esophageal intubation in the general anesthesia group. CONCLUSIONS: Out-patient shoulder reduction can be accomplished no matter whether general anesthesia, regional anesthesia, or intravenous analgesia alone was administered. Clinical outcome as measured by SF-36 and DASH was comparable among the three groups, but the shortest overall procedure time and greater patient satisfaction were found in patients with interscalene block.