Overview
Single-injection and continuous brachial plexus block techniques are used widely for postoperative analgesia in patients undergoing shoulder surgery. Although patient-reported outcomes are described in individual studies, their effects have not been synthesised comprehensively using a patient-centred framework. We sought to compare the effects of single-injection vs. continuous brachial plexus block techniques on patient-reported outcomes in adult patients following elective shoulder surgery. Databases were searched from inception to October 2025 and randomised controlled trials reporting patient-reported outcomes were included. Co-primary outcomes were postoperative patient-reported pain intensity at rest and during movement at 12 h, 24 h and 48 h post-surgery. Secondary outcomes included nausea and vomiting; sleep quality; patient satisfaction; opioid requests; and functional scores. Random-effects meta-analysis and trial sequential analysis were performed, with risk of bias and quality of patient-reported outcome reporting assessed. Twenty randomised controlled trials that included 1198 patients were analysed. Continuous brachial plexus blocks were associated with lower pain at rest at 12 h, 24 h and 48 h, with mean differences (MD) of -1.96 (95%CI -2.81 to -1.11, p < 0.001), -1.66 (95%CI -2.27 to -1.05, p < 0.001) and - 1.18 (95%CI -1.84 to -0.53, p < 0.001), respectively. Pain on movement could only be pooled at 24 h and 48 h and showed MD -2.04 (95%CI -4.26-0.19, p = 0.07) and - 1.30 (95%CI -3.67-1.07, p = 0.28) respectively. The co-primary outcomes approached or exceeded the predefined minimal clinically important difference for pain scores after shoulder surgery, in favour of continuous techniques. Continuous brachial plexus blocks are associated with better pain at rest and other patient-centred outcomes following shoulder surgery, while effects on dynamic pain and long-term functional recovery remain uncertain. We looked at many studies of people who had shoulder surgery. We compared two ways of giving pain relief using a nerve block: one where the local anaesthetic medicine is given once and another where it is given continuously through a small tube. We focused on how patients felt, including their pain, sleep and overall satisfaction. Shoulder surgery can be very painful and good pain control helps people recover better. Different nerve block methods are used, but it is not clear which one is best from the patient's point of view. We wanted to find out which method gives better pain relief and comfort. We found that the continuous method gave better pain relief when patients were resting during the first two days after surgery. It also helped improve other things like comfort and satisfaction. However, it was less clear if it helped with pain during movement or with longer‐term recovery. Overall, continuous nerve blocks seem to be better for early pain relief after shoulder surgery.
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Source
- AnaesthesiaRead Source →
