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Abstract Objective The COVID-19 pandemic led to an unprecedented pause in elective surgeries, including shoulder arthroplasty. We sought to determine whether clinical and/or demographic differences would be seen between patients who presented for shoulder arthroplasty during the pandemic compared with the previous year (2019). Methods Institutional records were queried for patients who underwent shoulder replacement between March 1 and July 1 of 2019 and 2020. Demographics, range of motion, surgical duration, hospitalization time, discharge disposition, and postoperative management were analyzed. Results The mean duration of surgery was 160 ± 50 minutes in 2020 and 179 ± 54 minutes in 2019 (p= 0.13). The mean hospitalization time was 36 ± 13 hours in 2020 and 51 ± 40 hours in 2019 (p= 0.04). In 2019, 96% of the patients participated in physical therapy, while 71% did it in 2020 (p= 0.003). A total of 100% of the 2019 patients and 86% of the 2020 patients participated in an in-person postoperative follow-up (p= 0.006). The 2019 patients reported for an office visit on average 14 ± 11 days after surgery; the 2020 patients waited 25 ± 25 days to return for a follow-up (p= 0.10). Range of motion, age, American Society of Anesthesiologists (ASA) scores, and complication rates did not differ between the cohorts. Conclusion Patients presenting for surgery during the initial phase of the pandemic were demographically and clinically similar to 2019 patients. However, the length of stay was significantly reduced during the COVID-19 pandemic. Postoperative follow-up and physical therapy were delayed in 2020, but this did not lead to differences in complication or readmission rates compared with those of the 2019 cohort. Level of EvidenceIII.
Resumo Objetivo A pandemia de COVID-19 causou uma pausa sem precedentes em cirurgias eletivas, inclusive artroplastia de ombro. Procuramos determinar as possíveis diferenças clínicas e/ou demográficas entre os pacientes que realizaram artroplastia de ombro durante a pandemia em comparação com o ano anterior (2019). Métodos Os registros institucionais foram consultados para obtenção de informações sobre pacientes submetidos a artroplastia de ombro entre 1° de março a 1° de julho de 2019 e 2020. Dados demográficos, amplitude de movimento, duração da cirurgia, tempo de hospitalização, condições à alta e manejo pós-operatório foram analisados. Resultados O tempo médio de cirurgia foi de 160 ± 50 minutos em 2020 e de 179 ± 54 minutos em 2019 (p= 0,13). O tempo médio de internação foi de 36 ± 13 horas em 2020 e de 51 ± 40 horas em 2019 (p= 0,04). Em 2019, 96% dos pacientes fizeram fisioterapia, enquanto 71% o fizeram em 2020 (p= 0,003). Todos os pacientes de 2019 e 86% dos pacientes de 2020 participaram do acompanhamento pós-operatório presencial (p= 0,006). Os pacientes de 2019 retornaram para a consulta médica em média 14 ± 11 dias após a cirurgia; os pacientes de 2020 retornaram para o acompanhamento em 25 ± 25 dias (p= 0,10). A amplitude de movimento, a idade, a pontuação da American Society of Anesthesiologists (ASA, na sigla em inglês) e as taxas de complicações não diferiram entre as coortes. Conclusão Os pacientes submetidos a cirurgia na fase inicial da pandemia eram demográfica e clinicamente semelhantes aos pacientes de 2019. No entanto, o tempo de internação diminuiu de forma significativa durante a pandemia de COVID-19. O acompanhamento pós-operatório e a fisioterapia foram adiados em 2020, mas isso não levou a diferenças nas taxas de complicações ou de reinternações em comparação às da coorte de 2019. Nível de EvidênciaIII.
Subject(s)
Humans , Postoperative Period , Elective Surgical Procedures , Perioperative Period , Arthroplasty, Replacement, Shoulder , COVID-19ABSTRACT
Objective:To analyze the efficacy of the reconstruction of the proximal humerus by reverse shoulder arthroplasty with three-dimensional (3D) printing technology after tumor rescetion.Methods:A retrospective analysis was conducted on the data of eight patients undergoing semi-constrained reverse shoulder arthroplasty with 3D printing technology after the resection of bone tumors in proximal humeri at the Affiliated Wuxi People's Hospital of Nanjing Medical University from December 2017 to January 2021. There were four males and four females with an average age of 55.1 (range, 31-73) years, all of whom had unilateral onset, 2 on the left and 6 on the right. There was one case of leiomyosarcoma (Enneking IIB), two cases of chondrosarcomas (one Enneking IA and one Enneking IB), four cases of Campanacci grade 3 giant cell tumor of bone, and one case of bone metastasis of lung adenocarcinoma. Individualized prosthesis and implantation protocol were completed preoperatively in all patients. The glenoid baseplate was manufactured using 3D printing technology. During the surgery, Malawer type I tumor resection and semi-constrained reverse shoulder arthroplasty were performed, with 6 cases simultaneously using allograft-prosthetic composite reconstruction. The follow-up was scheduled, and the patient received X-ray examination of the shoulder. The range of motion of the shoulder was measured, the Constant-Murley score and musculoskeletal tumor society (MSTS) score were recorded.Results:All 8 patients successfully completed the surgery, with a surgical time of 173.8±46.7 min (range, 130-260 min), intraoperative blood loss of 487.5±334.6 ml (range 200-1,200 ml), and proximal humeral resection of 9.9±4.6 cm (range, 4.5-19.0 cm). All patients were followed up for a period of 45.6±12.5 months (range, 24-60 months). At the last follow-up, the abduction ranges of motion of the affected shoulders increased from 27.5°±14.4° pre-operatively to 106.3°±21.8° post-operatively, with a statistically significant difference ( t=11.37, P<0.001). The forward flexion ranges increased from 28.1°±12.8° pre-operatively to 115.6°±24.0° post-operatively, with a statistically significant difference ( t=11.49, P<0.001). The Constant-Murley score was improved from 40.5±14.3 pre-operatively to 79.3±11.2 post-operatively, with a statistically significant difference ( t=9.58, P<0.001). The MSTS score was 25.6±2.2 (range, 23-28), including 6 excellent cases and 2 good cases. At 2 weeks after surgery, one patient experienced joint dislocation that was successfully reduced manually. Up to the final follow-up, all patients had survived without local tumor recurrence, metastasis, prosthesis infection and loosening. Conclusion:3D printing technology assisted shoulder arthroplasty is helpful for effective reconstruction and shoulder joint function recovery after resection of proximal humeral tumors, with satisfactory outcomes in the early and middle stages.
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Abstract Objective The present study aimed to evaluate the clinical outcomes of reverse shoulder arthroplasty to treat several conditions. Methods Retrospective, longitudinal study analyzing the Constant and University of California at Los Angeles (UCLA) scores and range of motion of patients undergoing reverse shoulder arthroplasty. Results In total, 28 patients were analyzed, with a mean age of 75.6 years old. The mean duration of follow-up was 45 months. Overall, there was a significant variation (p< 0.0001) between the preoperative (10.2 points) and the postoperative UCLA scores (29.6 points), corresponding to a relative increase of approximately 200%. In addition, the mean Constant score was 67.8, and the complication rate was 17.8%. As for functional outcomes per etiology, fracture sequelae cases presented the best mean elevation (165°), Constant score (79 points), postoperative UCLA score (32.5 points), and absolute delta UCLA score increase (22 points), but with no statistical significance. However, cases operated for fracture sequelae showed significantly higher elevation (p= 0.027) and Constant score (p= 0.047) compared to rotator cuff arthropathy cases. In addition, the lowest mean postoperative Constant and UCLA scores were observed for the following etiologies: primary arthrosis, acute fracture, and arthroplasty revision. Conclusion Reverse shoulder arthroplasty showed satisfactory functional outcomes and may be a treatment option not only for rotator cuff arthropathy but for several other conditions.
Resumo Objetivo Avaliar os resultados clínicos da artroplastia reversa do ombro no tratamento de suas diversas indicações. Métodos Estudo longitudinal retrospectivo que analisou os resultados dos escores Constant, UCLA e amplitudes de movimentos dos pacientes submetidos à artroplastia reversa do ombro. Resultados Foram analisados 28 pacientes, a média de idade foi de 75.6 anos, com seguimento médio de 45 meses. No geral, obtivemos uma variação significativa (p< 0,0001) entre o escore UCLA pré-operatório (10,2 pontos) e o escore UCLA pós-operatório (29,6 pontos), o que corresponde a um aumento relativo de aproximadamente 200%. Além disso, obtivemos pontuação média do escore Constant de 67,8 e uma taxa de complicações de 17,8%. Quanto aos resultados funcionais segundo as indicações, os casos de sequela de fratura apresentaram as melhores médias de elevação (165°), escore Constant (79 pontos), escore UCLA pós-operatório (32,5 pontos) e aumento absoluto na variação do escore UCLA (22 pontos), sem significância estatística. Porém, identificou-se que os casos operados por sequela de fratura apresentaram elevação (p= 0,027) e pontuação no escore Constant (p= 0,047) significativamente maiores em relação aos casos de artropatia do manguito rotador. Além disso, observamos que as menores médias dos escores Constant e UCLA pós-operatórios foram obtidos nas seguintes etiologias: artrose primária, fratura aguda e revisão de artroplastia. Conclusão A artroplastia reversa de ombro apresentou resultados funcionais satisfatórios, podendo ser uma opção de tratamento não somente nos casos de artropatia do manguito rotador, mas também em várias outras patologias.
Subject(s)
Humans , Male , Female , Shoulder/physiopathology , Rotator Cuff Injuries , Arthroplasty, Replacement, ShoulderABSTRACT
Objective:To compare the clinical effects of reverse shoulder arthroplasty and hemiarthroplasty in the treatment of three- or four-part proximal humeral fractures in the elderly.Methods:The clinical data of 58 elderly patients with three- or four-part proximal humeral fractures treated with hemiarthroplasty or reverse shoulder arthroplasty from June 2014 to June 2020 were retrospectively analyzed. Among them, 46 cases were from Sichuan Provincial Orthopaedic Hospital (22 cases of hemiarthroplasty and 24 cases of reverse shoulder arthroplasty), and 12 cases were from Tianjin Hospital (5 cases of hemiarthroplasty and 7 cases of reverse shoulder arthroplasty). In the hemiarthroplasty group, there were 27 patients, including 7 males and 20 females, with an average age of 70.29±6.81 years (range, 61-87 years), and there were 10 cases of 3-part fractures and 17 cases of 4-part fractures. In the reverse shoulder arthroplasty group, including 9 males and 22 females, with an average age of 75.06 ±4.25 years (range, 67-86 years), and there were 9 cases of 3-part fractures and 22 cases of 4-part fractures. The postoperative efficacy evaluation indexes included visual analogue scale (VAS), range of motion (ROM), prosthesis upward displacement, healing of greater tuberosity, scapular glenoid notch, American Shoulder and Elbow Surgeons (ASES) and Constant-Murley score.Results:The average follow-up was 50.63±16.02 months (range, 24-75 months) in the hemiarthroplasty group and 28.32±11.93 months (range, 14-56 months) in the reverse shoulder arthroplasty group. The anterior elevation in the reverse shoulder arthroplasty group was 118.22°±27.22°, and those in the hemiarthroplasty group was 102.77°±25.88°, which was significant difference ( t=2.21, P=0.032); the results of external rotation (ER) and internal rotation (IR) in two groups were similar, and no significant difference (ER: t=0.57, P=0.616; IR: χ 2=2.61, P=0.273); the average Constant-Murley and ASES in the reverse shoulder arthroplasty group were significantly better than those in the hemiarthroplasty group ( P=0.019 and 0.018); the complication rates of hemiarthroplasty group and reverse shoulder arthroplasty group were 37% (10/27) and 13% (4/31), respectively (χ 2=4.59, P=0.032). In the hemiarthroplasty group, 6 patients had upward movements of the prosthesis and 2 patients had wear of the glenoid side; notching (sirveaux grade 1) was noted in 1 patient in the reverse shoulder arthroplasty group. Conclusion:In the treatment of three- or four-part proximal humeral fractures in the elderly, reverse shoulder arthroplasty achieves significantly better functional results compared to hemiarthroplasty.
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Abstract Objective To evaluate the functional results of patients submitted to reverse shoulder arthroplasty for the treatment of rotator cuff arthropathy refractory to conservative treatment. Methods A retrospective study of 20 patients (21 shoulders), 17 women (81%) and 3 men (19%), underwent a reverse shoulder arthroplasty between October 2012 and September 2017, for a rotator cuff arthropathy treatment, operated by a single surgeon in a single center. The patients were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) score, the Short-Form (36) Health Survey (SF-36), the visual analogue scale (VAS) of pain rating, and the University of California - Los Angeles (UCLA) score. The mean age at surgery was of 66 years old (range: 55 to 83 years old). The duration of symptoms before surgery was of ∼ 2.5 years (range: 12 months to 6 years). The mean follow-up was of 42.4 months (range: 19 to 56.7 months). Results The mean postoperative scores were 18.2 points in DASH; 2 points in EVA, of which 16 (77%) corresponded to mild pain, 4 (18%) to moderate pain, and 1 (5%) to severe pain; 29 points in UCLA, of which 6 patients presented a regular result (28%), 10 patients a good result (48%), and 5 patients an excellent result (24%); and 63 points in the SF-36. The complications were four cases of notching, one case of acromial fracture due to stress, and one case of postoperative infection. Conclusions Reverse arthroplasty of the shoulder presents good functional results in the evaluated scores, providing a significant improvement in the quality of life of the patients.
Resumo Objetivo Avaliar os resultados funcionais dos pacientes submetidos a artroplastia reversa de ombro, para tratamento da artropatia do manguito refratária a tratamento conservador. Métodos Estudo retrospectivo de 20 pacientes (21 ombros), 17 mulheres (81%) e 3 homens (19%), submetidos a artroplastia reversa de ombro no período de outubro de 2012 a setembro de 2017, para tratamento de artropatia de manguito rotador, operados por um único cirurgião em um único centro. Os pacientes foram avaliados pelo escore de disfunções do braço, ombro e mão (DASH, na sigla em inglês), pelo questionário genérico de avaliação de qualidade de vida SF-36 (SF-36), pela escala visual analógica de dor (EVA) e pelo escore da Universidade de Los Angeles - Califórnia (UCLA, na sigla em inglês). A média de idade na cirurgia foi de 66 anos (variação de 55 a 83 anos). O tempo de sintomas antes da realização da cirurgia foi de ∼ 2,5 anos (variação de 12 meses a 6 anos). O seguimento médio foi de 42,4 meses (variação de 19 a 56,7 meses). Resultados A média dos escores pós-operatórios foi de 18,2 pontos no DASH; de 2 pontos na EVA, sendo 16 (77%) de dores leves, 4 (18%) de dores moderadas e 1 (5%) de dor intensa; de 29 pontos no UCLA, sendo 6 pacientes com resultado regular (28%), 10 pacientes com resultado bom (48%), e 5 pacientes com resultado excelente (24%); e de 63 pontos no SF-36. Tivemos como complicações quatro casos de notching, um caso de fratura de acrômio por estresse, e um caso de infecção pós-operatória. Conclusões A artroplastia reversa do ombro apresenta bons resultados funcionais nos escores avaliados, propiciando melhora significativa na qualidade de vida dos pacientes.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Pain , Shoulder/surgery , Signs and Symptoms , Surveys and Questionnaires , Retrospective Studies , Rotator Cuff , Rotator Cuff Tear Arthropathy , Rotator Cuff Injuries , Shoulder Injuries , Arthroplasty, Replacement, Shoulder , InfectionsABSTRACT
OBJECTIVE@#To investigate clinical results of reverse total shoulder arthroplasty in treating old fracture of proximal humerus in elderly patients.@*METHODS@#From January 2012 to December 2017, 12 elderly patients with old proximal humeral fractures were treated with reverse total shoulder arthroplasty. There were 5 males and 7 females with an average age of 70.2 years old (ranged from 63 to 81 years old) and an average course of 12.3 months (ranged from 9 to 18 months). VAS score was used to evaluate the degree of pain relief of shoulder joint, Constant-Murley score was used to evaluate the improvement of shoulder joint function and observe the complications during and after operation.@*RESULTS@#All the 12 patients were followed up with an average duration of 22.3 months (ranged from 15 to 56 months). At the latest follow-up, the VAS score was 1.9±1.4, and Constant-Murley score was 83.4±8.4. Among them, shoulder joint flexion was (92.5±7.7)°, abduction was (90.4±14.3)°, external rotation was(31.9±10.0)°, and internal rotation was(58.9±13.1)°. There was statistical significance before and after treatment(<0.05). There were 2 cases with glenoid notch. The imaging findings were grade I and grade II respectively. No loosening was found during follow-up. No infection, acromial fracture, prosthesis loosening, axillary nerve injury and other complications occurred.@*CONCLUSIONS@#Reverse total shoulder arthroplasty in treating old proximal humeral fractures in elderly patients can achieve satisfactory results, however, indications and complications should be noted.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Arthroplasty, Replacement, Shoulder , Humerus , Shoulder , Shoulder Fractures , General Surgery , Shoulder Joint , Treatment OutcomeABSTRACT
OBJECTIVE@#To observe and compare the shoulder joint function, complications and clinical effects of hemiarthroplasty and open reduction and locking plate in the treatment of comminuted proximal humeral fracture (Neer IV) with 3D printing technique.@*METHODS@#From March 2012 to April 2018, 31 middle age and elderly patients with comminuted proximal humeral fractures (Neer IV) were treated, including 4 males and 27 females, aged from 55 to 94 years old with an average age of 71 years, with a course of 1 to 3 years. Among them, 20 cases were treated with open reduction and locking plate internal fixation (ORIF group) and 11 cases were treated with lower half shoulder replacement (HA group) assisted by 3D printing technology. Using CT data and Mimics software of Materialise Company in Belgium, the reconstruction of fracture was simulated on computer. The height of fracture end to humeral head, the height of tubercle to humeral head, the angle of humeral head backward obliquity were measured to assist the hemiarthroplasty. Follow-up and X-ray examination were performed, the incidence of complications were observed, and Neer score was used for the shoulder joint function.@*RESULTS@#Thirty-one patients were followed up for 1 to 3 years with an average of 2 years. In HA group, there was no prosthesis loosening, fracture and subsidence, the head of artificial humerus was intact, the fracture of nodules and nodules did not heal in 1 case, Neer score was 84.18±3.55; in ORIF group, there were 8 cases of proximal humerus bone resorption, 1 case of fracture nonunion, 1 case of internal fixation loosening, Neer score was 55.91±10.78; there was significant difference in Neer score of shoulder joint function between the two groups(<0.05).@*CONCLUSIONS@#Ultrasound-guided minimal traverse-cross technique repair for acute closed Achilles tendon ruptures, which promise minimal incision, protect sural nerve, ensure quality of tendon anastomosis and fixation, and is a ideal method for repairing acute closed Achilles tendon ruptures.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bone Plates , Fracture Fixation, Internal , Fractures, Comminuted , Shoulder , Shoulder Fractures , General Surgery , Treatment OutcomeABSTRACT
OBJECTIVE@#To investigate clinical results of reverse total shoulder arthroplasty in treating comminuted fracture of proximal humerus in elderly patients with rotator cuff injury.@*METHODS@#From January 2017 to December 12, 12 comminuted fracture or dislocation of proximal humerus elderly patients were diagnosed as rotator cuff injury by preoperative MRI and operative exploration, and treated by reverse total shoulder arthroplasty. Among them, including 7 males and 5 females aged from 65 to 86 years old; 5 patients injured on the left side and 7 patients injured on the right side. Range of motion, postoperative complication were observed, VAS score was used to evaluate pain release and UCLA score was used to assess recovery of shoulder joint.@*RESULTS@#All patients were followed up from 8 to 18 months. At the latest follow-up, shoulder range of motion conditions were as following:forward bend and lifts ranged from 90° to 150°, external rotation ranged from 10°to 30°, internal rotation could reached L₃ level(S₁-L₁), VAS was for 0 to 6 points, UCLA score ranged from 18 to 32 points, 5 patients were good and 7 patients were poor. No infection, prothesis loosening, shoulder stress fracture, injury of vessel and nerve occurred.@*CONCLUSIONS@#Reverse total shoulder arthroplasty in treating comminuted fracture of proximal humerus in elderly patients with rotator cuff injury has advantages of early recovery of shoulder joint range of motion, less pain and high patients' satisfactory.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Arthroplasty, Replacement, Shoulder , Fractures, Comminuted , Humerus , Range of Motion, Articular , Rotator Cuff Injuries , Shoulder , Shoulder Fractures , General Surgery , Shoulder Joint , Treatment OutcomeABSTRACT
Distal humerus type C fracture is a rare and complicated intra-articular injury. Non-surgical treatment is difficult to achieve accurately reduction and reconstruction of articular surface, while open reduction and internal fixation is the best treatment option. Olecranon osteotomy could provide adequate surgical exposure, and is the most commonly used surgical method, but complications such as non-union osteotomy, internal fixation failure occurred. To avoid sacrificing integrity of olecranon, paratricipital approach, triceps reflecting approach, triceps reflectin ganconeus pedicle approach, triceps splitting and triceps tongue-shaped flap approach have been applied to fracture revealed. However, there is a certain contradiction of choice between surgical exposure and extension function of elbow due to limitations of different approaches. With the promotion of "double-column" theory, double plates has significant mechanical advantages over single plates. Even if parallel double-plate has more advantageous than vertical double-plate in vitro biomechanical experiments, it is not clear whether there is any difference between two methods in clinical application. Elbow arthroplasty may be the final choice for C-type fractures that could not be reconstructed on articular surface, but its long-term efficacy remains to be observed due to technical limitations.
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Com o advento das cirurgias artroscópicas, a abordagem da articulação do ombro passou a ser menos invasiva do que nos procedimentos convencionais. Apesar da redução da dor nos primeiros dias após o procedimento ser atribuída à técnica artroscópica, uma parcela significativa de pacientes relata dor de forte intensidade nas primeiras 24 a 48 horas de pósoperatório. A anestesia regional oferece alta qualidade de analgesia intra e pós-operatória. O bloqueio interescalênico é o padrão ouro para analgesia pós-operatória em cirurgias do ombro. O bloqueio seletivo dos nervos supraescapular e axilar surgiu como uma alternativa segura ao bloqueio interescalênico, mostrando alta eficácia. O objetivo do presente estudo foi comparar a qualidade da analgesia oferecida por duas técnicas de anestesia regional bloqueio interescalênico e o bloqueio seletivo dos nervos supra-escapular e axilar - para a analgesia pós-operatória em pacientes submetidos a cirurgia artroscópica de ombro para reparo de lesão do manguito rotador. Constituiu a amostra do estudo quarenta e sete pacientes com lesão do manguito rotador, tratados no Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad. Foram utilizados como parâmetros de comparação, o tempo necessário para a realização dos dois tipos de bloqueios, a necessidade de opioides para analgesia suplementar no pós-operatório, a ocorrência de complicações sistêmicas, a intensidade da dor, e sua possível relação com a duração da cirurgia. Todos os pacientes foram avaliados após 2h e 12h no pós-operatório. Os resultados mostraram eficácia e segurança das duas técnicas, sendo o tempo para a realização dos bloqueios seletivos maior. O bloqueio interescalênico oferece melhor qualidade de analgesia nas primeiras horas de pós-operatório em relação à técnica seletiva e com 12 horas a analgesia proporcionada pelos dois bloqueios é equivalente. O desconforto resultante da paralisia motora é prevalente e mais prolongado no bloqueio interescalênico e a necessidade de analgesia suplementar com opioide é maior no bloqueio seletivo apenas nas primeiras horas do pós-operatório e com 12 horas a demanda foi semelhante nos dois grupos. Não houve relação entre duração da cirurgia e dor pósoperatória. O conjunto dos nossos resultados demonstrou que as duas técnicas de analgesia que foram avaliadas mostraram-se seguras em pacientes isentos de comorbidades pulmonares. A técnica interescalênica tem como vantagem oferecer analgesia de melhor qualidade na primeiras horas do pós-operatório e ser realizada através de um único procedimento. Por outro lado tem duração mais curta e pode se associar a alguns efeitos adversos como paresia hemidiafragmática e hiperalgesia pós-bloqueio. Os bloqueios seletivos tem duração mais prolongada e se associam a eventos que podem ocorrer nos bloqueios regionais em geral. Como principal desvantagem do bloqueio seletivo, ressaltamos a necessidade da realização de dois procedimentos independentes, não oferecer anestesia do ombro em sua totalidade e a necessidade do treinamento específico por não ser uma técnica utilizada na rotina dos especialistas. Diante das vantagens e desvantagens, consideramos que cabe ao anestesiologista em decisão conjunta com o cirurgião, a escolha da técnica mais indicada para cada tipo de paciente, considerando a presença de comorbidades, a gravidade da lesão, o tempo de evolução clínica e o tipo de procedimento cirúrgico que está sendo proposto
With the advent of arthroscopic surgery, the approach of the shoulder joint has become less invasive than conventional procedures. Despite the reduction in pain in the first days after the procedure be attributed to arthroscopy, a significant number of patients report severe pain in the first 24 to 48 hours postoperatively. Regional anesthesia offers high quality intraoperative and postoperative analgesia. The interscalene block is the gold standard for postoperative analgesia for shoulder surgeries. Selective blocking of suprascapular and axillary nerves emerged as a safe alternative to interscalene block, with high rates of efficacy. The aim of this study was to compare the quality of analgesia offered by two regional anesthesia techniques - interescalenic block and selective block of suprascapular and axillary nerves - for postoperative analgesia in patients undergoing shoulder arthroscopic surgery to repair rotator cuff injury. The sample of the study comprised forty-seven patients with rotator cuff injury treated at the National Institute of Traumatology Jamil Haddad. It was used as comparison parameter, the time required to perform the two types of blocks, the amount of opioid needed as additional analgesia postoperatively, the occurrence of systemic complications, pain intensity, and its relation to surgery duration. All patients were evaluated after 2 h and 12 h postoperatively. The results showed efficacy and safety of the two techniques; however the time to perform the selective blocks was greater. The interscalene block provides better analgesia in the early hours after surgery compared to the selective technique and analgesia provided by the two blocks after 12 hours was equivalent. The discomfort resulting of motor paralysis was prevalent and longer in the interscalene block. The need for additional analgesia with opioids was higher in selective blocks only in the first hours of the postoperative period with similar demand in both groups after 12 hours. There was no relationship between duration of surgery and postoperative pain. Taken together, our results demonstrated that both analgesia techniques that were evaluated were safe for patients without pulmonary comorbidities. The interscalene technique has the advantage of offering better quality of analgesia in the first hours of the postoperative period and to be carried out through a single procedure. On the other hand it has a shorter duration and may be associated with some adverse effects such as hemidiaphragmatic paresis and post-block hyperalgesia. The selective block lasts longer and is associated with events that may occur in regional blocks in general. As a main disadvantage of the selective block, we emphasize the need to carry out two independent procedures, do not offer shoulder anesthesia in its integrity and the need for specific training considering that is not used routinely. Taking into account the advantages and disadvantages of both techniques, we believe that it is up to the anesthesiologist, in a joint decision with the surgeon, to decide the technique more appropriate for each type of patient considering the presence of comorbidities, severity of the injury, the duration of clinical symptoms and the type of surgical procedure that is being proposed