Ambulatory Catheter-based Interscalene Block for Proximal Humerus Fracture Rehabilitation: Safety, Efficacy and Lessons from a Pilot Study
Introduction: Proximal humerus fractures (PHFs) are associated with morbidity/functional impairment. Rehabilitation adherence is crucial to regain independent function yet is often hindered by pain. This pilot study aims to analyse the safety and efficacy of ambulatory catheter-based interscalene bl...
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Malaysian Orthopaedic Association
2025-07-01
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| Series: | Malaysian Orthopaedic Journal |
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| Online Access: | https://www.morthoj.org/2025/v19n2/ambulatory-catheter-block.pdf |
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| author | Nah MFK Seng ZQ Tan YJB |
| author_facet | Nah MFK Seng ZQ Tan YJB |
| author_sort | Nah MFK |
| collection | DOAJ |
| description | Introduction: Proximal humerus fractures (PHFs) are associated with morbidity/functional impairment. Rehabilitation adherence is crucial to regain independent function yet is often hindered by pain. This pilot study aims to analyse the safety and efficacy of ambulatory catheter-based interscalene blocks (CISBs) as analgesia in post-surgical PHF patients and summarise learning points to guide further implementation/study of ambulatory CISB.
Materials and methods: This pilot study selected PHF patients who were >18yo, surgically treated and received ambulatory CISB (CISB ≥72 hours). Data was derived from clinical documentation (anaesthetist/surgeon/therapist reviews). Clinical outcomes (e.g. range of motion, Quick Disability of Arm/Shoulder/Hand (qDASH) scores), dynamic/resting pain scores and incidence of CISB-related complications were collected.
Results: Twelve patients were selected with mean ambulatory CISB duration of 9.5 days. All patients improved clinically, with means improvements of +64.6° and +61.9° for passive flexion and abduction, and reduction of 29.8 in qDASH after 3 months. Two patients experienced neurological complications (phrenic nerve palsy; medial forearm numbness) while six patients experienced catheter-based complications (dislodgment, erythema). All complications were self-limiting, resolving with removal of catheter.
Conclusion: Ambulatory CISB can minimise pain and facilitate rehabilitation for PHF patients. Learning points include (1) complications are predictable and incidence/physiological impact on patients can be minimised via appropriate patient selection, (2) standardised protocols (e.g. tunnelling of catheters) help maximise utility of ambulatory CISB while minimising complications, (3) regular monitoring/anticipation of complications facilitate early detection and prompt management. These learning points, combined with existing literature, can be adapted to future applications of ambulatory CISB to better study its safety and efficacy. |
| format | Article |
| id | doaj-art-693adb7fc6374bbe9a98ededc7a87a88 |
| institution | Kabale University |
| issn | 1985-2533 2232-111X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Malaysian Orthopaedic Association |
| record_format | Article |
| series | Malaysian Orthopaedic Journal |
| spelling | doaj-art-693adb7fc6374bbe9a98ededc7a87a882025-08-20T03:39:32ZengMalaysian Orthopaedic AssociationMalaysian Orthopaedic Journal1985-25332232-111X2025-07-0119219doi.org/10.5704/MOJ.2507.011Ambulatory Catheter-based Interscalene Block for Proximal Humerus Fracture Rehabilitation: Safety, Efficacy and Lessons from a Pilot StudyNah MFK0Seng ZQ1 Tan YJB2Department of Orthopaedic Surgery, Tan Tock Seng Hospital, SingaporeDepartment of Anaesthesiology, Woodlands Health Campus, SingaporeDepartment of Orthopaedic Surgery, Woodlands Health Campus, SingaporeIntroduction: Proximal humerus fractures (PHFs) are associated with morbidity/functional impairment. Rehabilitation adherence is crucial to regain independent function yet is often hindered by pain. This pilot study aims to analyse the safety and efficacy of ambulatory catheter-based interscalene blocks (CISBs) as analgesia in post-surgical PHF patients and summarise learning points to guide further implementation/study of ambulatory CISB. Materials and methods: This pilot study selected PHF patients who were >18yo, surgically treated and received ambulatory CISB (CISB ≥72 hours). Data was derived from clinical documentation (anaesthetist/surgeon/therapist reviews). Clinical outcomes (e.g. range of motion, Quick Disability of Arm/Shoulder/Hand (qDASH) scores), dynamic/resting pain scores and incidence of CISB-related complications were collected. Results: Twelve patients were selected with mean ambulatory CISB duration of 9.5 days. All patients improved clinically, with means improvements of +64.6° and +61.9° for passive flexion and abduction, and reduction of 29.8 in qDASH after 3 months. Two patients experienced neurological complications (phrenic nerve palsy; medial forearm numbness) while six patients experienced catheter-based complications (dislodgment, erythema). All complications were self-limiting, resolving with removal of catheter. Conclusion: Ambulatory CISB can minimise pain and facilitate rehabilitation for PHF patients. Learning points include (1) complications are predictable and incidence/physiological impact on patients can be minimised via appropriate patient selection, (2) standardised protocols (e.g. tunnelling of catheters) help maximise utility of ambulatory CISB while minimising complications, (3) regular monitoring/anticipation of complications facilitate early detection and prompt management. These learning points, combined with existing literature, can be adapted to future applications of ambulatory CISB to better study its safety and efficacy.https://www.morthoj.org/2025/v19n2/ambulatory-catheter-block.pdforthopaedic surgerynerve block catheterspost-operative painproximal humerus fracture |
| spellingShingle | Nah MFK Seng ZQ Tan YJB Ambulatory Catheter-based Interscalene Block for Proximal Humerus Fracture Rehabilitation: Safety, Efficacy and Lessons from a Pilot Study Malaysian Orthopaedic Journal orthopaedic surgery nerve block catheters post-operative pain proximal humerus fracture |
| title | Ambulatory Catheter-based Interscalene Block for Proximal Humerus Fracture Rehabilitation: Safety, Efficacy and Lessons from a Pilot Study |
| title_full | Ambulatory Catheter-based Interscalene Block for Proximal Humerus Fracture Rehabilitation: Safety, Efficacy and Lessons from a Pilot Study |
| title_fullStr | Ambulatory Catheter-based Interscalene Block for Proximal Humerus Fracture Rehabilitation: Safety, Efficacy and Lessons from a Pilot Study |
| title_full_unstemmed | Ambulatory Catheter-based Interscalene Block for Proximal Humerus Fracture Rehabilitation: Safety, Efficacy and Lessons from a Pilot Study |
| title_short | Ambulatory Catheter-based Interscalene Block for Proximal Humerus Fracture Rehabilitation: Safety, Efficacy and Lessons from a Pilot Study |
| title_sort | ambulatory catheter based interscalene block for proximal humerus fracture rehabilitation safety efficacy and lessons from a pilot study |
| topic | orthopaedic surgery nerve block catheters post-operative pain proximal humerus fracture |
| url | https://www.morthoj.org/2025/v19n2/ambulatory-catheter-block.pdf |
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