A novel combination of peripheral nerve blocks for arthroscopic shoulder surgery.

BACKGROUND: Interscalene brachial plexus block is currently the gold standard for intra- and post-operative pain management for patients undergoing arthroscopic shoulder surgery. However, it is associated with block related complications, of which effect on the phrenic nerve have been of most interest. Side effects caused by general anesthesia, when this is required, are also a concern. We hypothesized that the combination of superficial cervical plexus block, suprascapular nerve block, and infraclavicular brachial plexus block would provide a good alternative to interscalene block and general anesthesia. METHODS: Twenty adult patients scheduled for arthroscopic shoulder surgery received a combination of superficial cervical plexus block (5 ml ropivacaine 0.5%), suprascapular nerve block (4 ml ropivacaine 0.5%), and lateral sagittal infraclavicular block (31 ml ropivacaine 0.75%). The primary aim was to find the proportion of patients who could be operated under light propofol sedation, without the need for opioids or artificial airway. Secondary aims were patients' satisfaction and surgeons' judgment of the operating conditions. RESULTS: Nineteen of twenty patients (95% CI: 85-100) underwent arthroscopic shoulder surgery with light propofol sedation, but without opioids or artificial airway. The excluded patient was not comfortable in the beach chair position and therefore received general anesthesia. All patients were satisfied with the treatment on follow-up interviews. The surgeons rated the operating conditions as good for all patients. CONCLUSION: The novel combination of a superficial cervical plexus block, a suprascapular nerve block, and an infraclavicular nerve block provides an alternative anesthetic modality for arthroscopic shoulder surgery.

Could tendinosis be involved in osteoarthritis?

Ten patients, age 60 (48-75 years), with osteoarthritis (OA) of the hip and 10 patients, age 82.5 (60-90 years), with fracture of the collum femoris (FCF; minimum Garden stage III) underwent an open biopsy procedure from the internal obturator tendon in conjunction with a total hip replacement. The histological evaluation revealed that all tendon samples in the OA group revealed scar tissue; the corresponding was found in 50% of patients in the FCF group (P=0.02). There were also more GAGs (P=0.023) and calcium deposits (P=0.001) in the samples from the OA group. The ultrastructural evaluation revealed fewer small and medium-sized fibrils (P=0.001) and more non-collagenous extracellular matrix (ECM) (P=0.003) in the OA group. Taken together, the samples from the internal obturator tendon in the OA group revealed a more degenerative appearance with more scar tissue, change in fibril diameter distribution and more non-collagenous ECM. Our findings suggest that OA and periarticular tendinopathy are closely linked. Further research is needed to determine whether musculotendinous changes in the deep rotators are sequelae of joint pathology, or a contributing factor in the development of degenerative joint change.