Thomas Mutter1, Gabrielle S Logan2, Sam Neily2, Scott Richardson2, Nicole Askin3, Marita Monterola2, Ahmed Abou-Setta4. 1. Department of Anesthesiology, Perioperative and Pain Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada. tmutter@hsc.mb.ca. 2. Department of Anesthesiology, Perioperative and Pain Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada. 3. Neil John Maclean Health Sciences Library, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. 4. George and Fay Yee Centre for Healthcare Innovation, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Abstract
OBJECTIVE: Postoperative neurologic symptoms (PONS) in the operative arm are important complications of shoulder surgery and interscalene blockade (ISB). This systematic review aimed to compare the risk of PONS between ISB and other techniques, and the relative safety of different agents used in ISB. METHODS: Our systematic review followed Cochrane review methodology and was registered in PROSPERO. A search of MEDLINE (Ovid), EMBASE (Ovid), and CENTRAL (Wiley) from inception to June 2020 was completed. We included randomized or quasi-randomized trials of patients (> five years old) undergoing shoulder surgery with any ISB technique as an intervention, compared with any other nonregional or regional technique, or ISB of alternate composition or technique. The primary outcome was PONS (study author defined) assessed a minimum of one week after surgery. RESULTS: Fifty-five studies totalling 6,236 participants (median, 69; range, 30-910) were included. Another 422 otherwise eligible trials were excluded because PONS was not reported. Heterogeneity in when PONS was assessed (from one week to one year) and the diagnostic criteria used precluded quantitative meta-analysis. The most common PONS definition, consisting of one or more of paresthesia, sensory deficit, or motor deficit, was only used in 16/55 (29%) trials. Risk of bias was low in 5/55 (9%) trials and high in 36/55 (65%) trials, further limiting any inferences. CONCLUSION: These findings highlight the need for a standardized PONS outcome definition and follow-up time, along with routine, rigorous measurement of PONS in trials of ISB. STUDY REGISTRATION: PROSPERO (CRD42020148496); registered 10 February 2020.
OBJECTIVE: Postoperative neurologic symptoms (PONS) in the operative arm are important complications of shoulder surgery and interscalene blockade (ISB). This systematic review aimed to compare the risk of PONS between ISB and other techniques, and the relative safety of different agents used in ISB. METHODS: Our systematic review followed Cochrane review methodology and was registered in PROSPERO. A search of MEDLINE (Ovid), EMBASE (Ovid), and CENTRAL (Wiley) from inception to June 2020 was completed. We included randomized or quasi-randomized trials of patients (> five years old) undergoing shoulder surgery with any ISB technique as an intervention, compared with any other nonregional or regional technique, or ISB of alternate composition or technique. The primary outcome was PONS (study author defined) assessed a minimum of one week after surgery. RESULTS: Fifty-five studies totalling 6,236 participants (median, 69; range, 30-910) were included. Another 422 otherwise eligible trials were excluded because PONS was not reported. Heterogeneity in when PONS was assessed (from one week to one year) and the diagnostic criteria used precluded quantitative meta-analysis. The most common PONS definition, consisting of one or more of paresthesia, sensory deficit, or motor deficit, was only used in 16/55 (29%) trials. Risk of bias was low in 5/55 (9%) trials and high in 36/55 (65%) trials, further limiting any inferences. CONCLUSION: These findings highlight the need for a standardized PONS outcome definition and follow-up time, along with routine, rigorous measurement of PONS in trials of ISB. STUDY REGISTRATION: PROSPERO (CRD42020148496); registered 10 February 2020.
Authors: Brian Daniel Sites; Andreas H Taenzer; Michael D Herrick; Constance Gilloon; John Antonakakis; Janeen Richins; Michael L Beach Journal: Reg Anesth Pain Med Date: 2012 Sep-Oct Impact factor: 6.288
Authors: Kenneth D Candido; Radha Sukhani; Robert Doty; Antoun Nader; Mark C Kendall; Edward Yaghmour; Tripti C Kataria; Robert McCarthy Journal: Anesth Analg Date: 2005-05 Impact factor: 5.108
Authors: William J Warrender; Usman Ali M Syed; Sommer Hammoud; William Emper; Michael G Ciccotti; Joseph A Abboud; Kevin B Freedman Journal: Am J Sports Med Date: 2016-10-13 Impact factor: 6.202
Authors: Tim Dwyer; Patrick D G Henry; Phantila Cholvisudhi; Vincent W S Chan; John S Theodoropoulos; Richard Brull Journal: Reg Anesth Pain Med Date: 2015 Sep-Oct Impact factor: 6.288
Authors: Joseph M Neal; Michael J Barrington; Richard Brull; Admir Hadzic; James R Hebl; Terese T Horlocker; Marc A Huntoon; Sandra L Kopp; James P Rathmell; James C Watson Journal: Reg Anesth Pain Med Date: 2015 Sep-Oct Impact factor: 6.288