Postoperative neurological symptoms following arthroscopic shoulder surgery with interscalene block: an exploratory secondary analysis of pooled randomized controlled trial data
Authors' conclusion
PONS are common after arthroscopic shoulder surgery performed with single injection ultrasound-guided interscalene blocks. No definitive mitigating risk factors were identified.
Study context
- Population
- Adults ≥18 years undergoing arthroscopic shoulder surgery with interscalene block (perineural or IV adjuvants) at a single ambulatory surgical center
- Participants
- 477 adults · 2 RCTs
- Primary endpoint
- Postoperative neurological symptoms (PONS): patient-reported numbness, weakness or tingling in the surgical limb, alone or in combination, regardless of severity or etiology
- Follow-up
- 14 days
Methodological detailsexploratory, pooled data from two RCTs, single ambulatory surgical center
- Exploratory
- Pooled data from two RCTs
- Single ambulatory surgical center
Primary result
As reported in the abstract
PONS at 14 days
Postoperative neurological symptoms (PONS) prevalence (83 of 477 patients)
17.4%
Further findings
Factors associated with 14-day PONS (exploratory univariate analyses)
| OR (95% CI) | P value | ||
|---|---|---|---|
| Lower postoperative day 1 Quality of Recovery-15 questionnaire total scoreExploratory univariate analyses | 0.97 (0.96–0.99) | P < 0.01 | |
| Emotional domain question scoresExploratory univariate analyses | 0.90 (0.85–0.96) | P < 0.001 | |
| 0.512Odds ratio (log scale) |
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Persistent PONS at 6 months by 14-day symptom combinationAll three of numbness, weakness and tingling at 14 days vs other 14-day symptom combinations | 11.5 (2.2–61.8) | P < 0.01 | |
| 0.050.21520Odds ratio (log scale) |
Persistence of PONS at 6 months among patients with 14-day PONS
- Continued to have symptoms a half-year after surgery
- 10 (12.0%)
Factors associated with 14-day PONS (exploratory univariate analyses)
- No patient, surgical or anesthetic characteristics significantly associated with 14-day PONS except lower POD 1 QoR-15 total score
Original publication
Postoperative neurological symptoms following arthroscopic shoulder surgery with interscalene block: an exploratory secondary analysis of pooled randomized controlled trial data. Reg Anesth Pain Med. Published 9 June 2023. doi:10.
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