مرکز منطقه ای اطلاع رساني علوم و فناوري - Functional results of conservative therapy accompanied by interscalane brachial plexus block and patient-controlled analgesia in cases with frozen shoulder

Latin Abstract :

Objectives: We evaluated the efficacy of simultaneous interscalene block and catheter analgesia applied as an aid to conservative treatment in improving shoulder functions in patients with fro¬zen shoulder. Methods: Three patients (2 women, 1 man; mean age 47 years) with frozen shoulder underwent conservative treatment including manipulation under interscalene brachial plexus block and sub¬sequent rehabilitation under catheter analgesia to improve shoulder range of motion and function. Following manipulation under interscalene block, the patients were hospitalized for 15 to 28 days (mean 21 days) for an exercise program performed by a physiotherapist and orthopedist at least twice a day under interscalene catheter analgesia. Thirty minutes before each rehabilitation session, patient-controlled analgesia was administered via a pain relief pump. Active and passive range of motion (ROM) were measured and the severity of pain was rated using a visual analog scale (VAS) prior to and following interscalene block, during the exercise program, and at the end of the treat¬ment. Functional assessments were made before and after treatment using the University of Cali¬fornia in Los Angeles (UCLA) Shoulder Scale. The exercise program under interscalene analgesia was performed until pain-free and sufficient active movements were obtained, with at least 80% improvement in active and passive motion, a VAS score of 0-2, and an UCLA score of >27. Results: Compared to pretreatment values, the ROM values showed remarkable increases at the end of the treatment. Active ROM reached at least 30° external rotation, 40° internal rotation, 150° flexion, 45° extension, and 100° abduction in all cases. On presentation, the VAS scores of all cases were 10 for both active and passive movements, whereas they ranged from 0 to 2 on discharge. The mean UCLA score increased from 12.3 to 30.3 after treatment. Immediately after the interscalene block, two patients exhibited signs of Hornerʹs syndrome which resolved sponta¬neously within an hour without the need for treatment. No complications or catheter-related prob¬lems such as infection, break-off, or displacement developed throughout the treatment period. There was no requirement for additional analgesia. Conclusion: In patients with frozen shoulder, interscalene block and continuous patient-controlled analgesia via an interscalene catheter provided sufficient analgesia and contributed to the recov¬ery of shoulder functions through an effective and safe exercise program, with no side effects or complications. However, further studies are needed to assess the feasibility of home applications of interscalene patient-controlled analgesia to increase cost-effectiveness and patient satisfaction.