Effect of an Interscalene Block Combined With Intravenous Dexamethasone on Pain After Rotator Cuff Repair

TL;DR

Combining an interscalene block with intravenous dexamethasone significantly reduces postoperative pain and the need for additional painkillers after rotator cuff surgery.

Contribution

This study demonstrates that intravenous dexamethasone combined with interscalene block improves postoperative pain management compared to the block alone.

Findings

Patients receiving intravenous dexamethasone had a 63% rescue drug use rate versus 97% in the control group.

The time to first rescue drug use was significantly longer in the dexamethasone group (21.7 hours vs. 9.3 hours).

Rescue drug frequency was significantly lower in the dexamethasone group at 12, 24, and 72 hours post-surgery.

Abstract

Background

Shoulder joint surgery is associated with severe postoperative pain, necessitating effective pain control methods. While interscalene block is a widely used technique for postoperative pain relief, its duration is limited, and rebound pain often occurs. Combining interscalene block with dexamethasone has shown promise in extending pain relief, but the relative effectiveness of intravenous versus mixed administration remains unclear. This study aimed to evaluate the effects of intravenous dexamethasone combined with interscalene block on pain control after arthroscopic rotator cuff repair (ARCR).

Methodology

A retrospective study was conducted on 73 ARCR patients who received general anesthesia and interscalene block between 2018 and 2023. Patients were divided into two groups: those receiving an interscalene block with intravenous dexamethasone (group D, n = 41) and those receiving an interscalene block alone (group C, n = 32). Primary outcomes included postoperative rescue drug use and the time to first rescue drug use. Secondary outcomes included the frequency of rescue drug use within 12, 24, and 72 hours post-surgery. Statistical analysis was performed using the Mann-Whitney U test and the chi-square test.

Results

Group D had a significantly lower rate of rescue drug use (26, 63%) compared to group C (31, 97%; P < 0.001). The time to first rescue drug use was significantly longer in group D (21.7 ± 9.8 hours) than in group C (9.3 ± 8.3 hours, P < 0.001). The frequency of rescue drug use within 12, 24, and 72 hours post-surgery was also significantly lower in group D (P < 0.001). No complications were observed in either group.

Conclusions

Intravenous dexamethasone combined with interscalene block significantly reduced the need for postoperative painkillers and prolonged the duration of pain relief after ARCR. This combination is a promising method for effective postoperative pain management.

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