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Pinprick Test May Identify Posterior Portal Pain Risk in Awake Shoulder Arthroscopy
In a prospective, single-center observational cohort of 97 adults undergoing shoulder arthroscopy with regional anesthesia, investigators assessed whether sharp pinprick sensation at the planned posterior portal predicted trocar pain. Four patients reported clinically relevant pain; all had sharp sensation on testing, although the test’s positive predictive value was 40%.
- Four of 97 patients had clinically relevant trocar pain.
- All four reported sharp sensation during preincision testing.
- Positive predictive value was 40% in this cohort.
- Infiltration was given to test-positive patients.
Awake shoulder arthroscopy under regional anesthesia can leave residual sensation at the posterior portal, which may lie between the sensory territories covered by interscalene and superficial cervical plexus blocks. In this prospective observational study, 97 adults received both blocks and underwent a preincision pinprick test at the surgeon-designated posterior portal. Patients reporting sharp sensation received local ropivacaine infiltration; the primary outcome was pain of at least 4 on a 0-to-10 numeric rating scale during posterior trocar insertion.
Sharp sensation was present in 10 patients (10.3%). Four of these 10 reported clinically relevant trocar pain, compared with none of the 87 patients without sharp sensation. Test sensitivity was 100% (4/4; 95% CI, 39.8–100.0), specificity 93.5% (87/93), and positive predictive value 40% (4/10). Two patients in the sharp-sensation group converted to general anesthesia for persistent portal pain; one patient without sharp sensation converted because of anxiety during a prolonged repair.
The findings suggest the test may help identify patients who need additional attention at the posterior portal, but estimates are imprecise because only four patients experienced the primary outcome. Because test-positive patients received infiltration, the study cannot establish how outcomes would differ without it. The single-center design and use of a specific block regimen also limit generalizability; the study was not powered for rare events or subgroup comparisons.
In practice
For adults undergoing awake shoulder arthroscopy with the studied interscalene and superficial cervical plexus blocks, sharp pinprick sensation at the planned posterior portal was associated with greater observed trocar-pain risk: all four patients with pain tested positive. However, only four primary events occurred, yielding wide uncertainty, and the positive predictive value was 40%. Test-positive patients received local infiltration, so the study does not show whether testing or infiltration improves outcomes, and it does not justify changing practice on its own.
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Anesthesiology: Preincision Soft-point Pinprick Testing during Awake Shoulder Arthroscopy after Interscalene and Superficial Cervical Plexus Blocks ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.