Current Concepts in Regional Analgesia Techniques for Postoperative Pain Management after Total Shoulder Arthroplasty: A Narrative Review

Vol 3 | Issue 2 | July-December 2022 | Page 42-48 | Prasanna Khare, Rijuta Kashyapi, Manjiri Ranade

DOI: 10.13107/ijra.2022.v03i02.055

Authors: Prasanna Khare [1], Rijuta Kashyapi [1], Manjiri Ranade [1]

[1] Department of Anaesthesiology, Deenanath Mangeshkar Hospital & Research Centre, Pune, Maharashtra, India.

Address of Correspondence
Dr. Manjiri Ranade
Department of Anaesthesiology, Deenanath Mangeshkar Hospital & Research Centre, Pune, Maharashtra, India.


Postoperative pain management after total shoulder arthroplasty (TSA) can be challenging. Interscalene brachial plexus block, which is administered either as since injection (ssISB) or with continuous catheter (ccISB) technique, is the gold standard. Ultrasonography (USG) guidance facilitates a faster, more accurate block with a lower local anaesthetic volume in ssISB. USG also helps for accurate catheter placement in ccISB. Hemi-diaphragmatic palsy is a common complication of ISB. This can be a major concern for patients with a respiratory compromise so it necessitates the administration of diaphragm-sparing nerve blocks. Phrenic nerve sparing block like suprascapular nerve block (SSNB) singly or along with axillary nerve block, subomohyoid anterior suprascapular block, superior trunk block, erector spinae plane block, individually, provide perioperative analgesia non-inferior to ISB. Subacromial or intraarticular infiltration of local anaesthesia (SAIA) is not recommended due to its limited clinical efficacy. Extended analgesic effects have been observed with liposomal bupivacaine when used as a field block. This article provides an overview of regional anaesthesia techniques for postoperative analgesia following Total shoulder arthroplasty (TSA)
Keywords: Shoulder arthroplasty, Pain management, Regional anaesthesia, Interscalene brachial plexus block


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How to Cite this Article: Khare P, Kashyapi R, Ranade M | Current Concepts in Regional Analgesia Techniques for Postoperative Pain Management after Total Shoulder Arthroplasty: A Narrative Review | International Journal of Regional Anaesthesia | July-December 2022; 3(2): 42-48.

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Current Concepts in Pain Management of Total Knee Replacement Surgeries: A Narrative Review

Vol 3 | Issue 2 | July-December 2022 | Page 56-75 | Kartik Sonawane, Jagannathan Balavenkatasubramanian

DOI: 10.13107/ijra.2022.v03i02.057

Authors: Kartik Sonawane [1], Jagannathan Balavenkatasubramanian [2]

[1] Department of Anaesthesia, Ganga Medical Centre & Hospitals Pvt. Ltd. , Coimbatore, Tamil Nadu, India.

Address of Correspondence
Dr. Jagannathan Balavenkatasubramanian,
Department of Anaesthesia, Ganga Medical Centre & Hospital, Coimbatore, Tamil Nadu, India.


Total knee replacement/arthroplasty (TKR/TKA) is considered a life-changing surgery as it not only corrects the pathology and associated joint deformity but also renders the patient pain-free allowing them to perform activities of daily living as before. Such favorable outcomes depend entirely on the perioperative pain management strategies. Structuring such strategies requires background knowledge of the goals set, the process of pain generation before and after the surgery, and innervations of the pain-generating components involved in each surgical step.
The multifactorial origin of TKR pain requires a multidimensional pain management strategy such as multimodal analgesia (MMA). It should incorporate all the essential ingredients that target each step of the pain generation process. Apart from pharmacological agents and nonpharmacological techniques, regional analgesia (RA) plays a very important role as an adjunct to MMA to provide quality analgesia that promotes enhanced recovery and mobility. However, the choice of RA technique remains dependent on its motor-sparing effect, procedure-specific analgesic coverage, opioid-sparing effect, and suitability for enhanced recovery after surgery (ERAS). Psychological analgesia is also an important aspect of MMA, aiding in resolving psychological concerns and postoperative pain management and empowering patients in their own pain management process by encouraging active participation. In addition to providing appropriate pain management services, assessing expected outcomes in the postoperative period is also important to close loopholes and provide rescue analgesics when needed.
This narrative review article highlights important aspects of pain management strategies and the essential requirements for implementing them to achieve desired outcomes. We believe this article will help readers design or modify their pain management strategy to meet all of their goals.
Keywords: Total knee replacement, Total knee arthroplasty, Pain management, Motor-sparing regional anesthetic technique, Multimodal analgesia, Procedure-specific analgesia.


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How to Cite this Article: Sonawane K, Balavenkatasubramanian J | Current Concepts in Pain Management of Total Knee Replacement Surgeries: A Narrative Review | International Journal of Regional Anaesthesia | July-December 2022; 3(2): 56-75.

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