Joint replacement (primary): hip, knee and shoulder

Recommendation ID: NG157/8
Question: In adults having elective shoulder joint replacement with general anaesthesia, what is the clinical and cost effectiveness of supplementary local infiltration analgesia, a nerve block or regional anaesthesia?
Any explanatory notes (if applicable): Full details of the research recommendation are in evidence review F: anaesthesia for shoulder replacement.

Why the committee made the recommendation

There was not enough evidence to support recommendations on specific types of anaesthesia for shoulder replacement. Because of this uncertainty, the committee stressed the importance of discussing the options with people having this type of joint replacement. Although small benefits were seen in studies combining general anaesthesia with LIA and regional anaesthesia with LIA, they were offset by phrenic nerve palsy events. The committee made recommendations for research on supplementary analgesia or anaesthesia and regional, general, or regional with general anaesthesia in shoulder replacement. They noted that using regional anaesthesia alone has the potential to increase day-case shoulder replacement surgery.

How the recommendation might affect practice

This recommendation is not expected to change current practice.

Source guidance details

Is this a recommendation for the use of a technology only in the context of research?	No
Is it a recommendation that suggests collection of data or the establishment of a register?	No
Last Reviewed	01/06/2020