Interscalene Brachial Plexus Block with a Continuous Catheter Insertion System and a Disposable Infusion Pump

Abstract

Continuous interscalene brachial plexus blockade traditionally requires a hospital stay for local anesthetic infusion, and achieving consistent catheter insertion may be difficult. Incorporating long-acting pain relief from a continuous peripheral nerve block, with a reliable method of catheter insertion, and a self-contained infusion system would be a valuable asset for short-stay care. We compared the efficacy of single injection interscalene brachial plexus blockade to a continuous peripheral nerve block, with an insulated Tuohy system and a disposable infusion pump. Forty adult patients scheduled for open rotator cuff repair were entered in this randomized, double-blinded, placebo-controlled study. Patients received an interscalene brachial plexus blockade and a continuous peripheral nerve catheter as their primary anesthetic and then, were assigned to receive one of two different postoperative infusions: either 0.2% ropivacaine at 10 mL/h via a disposable infusion pump or normal saline at 10 mL/h via a disposable infusion pump (n = 18-20 per group). Visual analog pain scores and postoperative morphine consumption were measured for 24 h. The ropivacaine group showed less pain than the placebo group (P: = 0.0001) between 12 and 24 h after the initial injection of local anesthetic. In addition, initial interscalene blockade was successful in all patients and all redosed catheters were functional after 24 h with the continuous catheter insertion system. We conclude that it is possible to achieve a high rate of successful catheter placement and analgesia by using the continuous catheter insertion system and a disposable infusion pump in the ambulatory setting. This method of analgesia may offer improved pain relief after outpatient rotator cuff repair.

Continuous peripheral nerve blocks for postoperative analgesia in children: feasibility and side effects in a cohort study of 339 catheters

“…Similarly, Klein et al 18,19 observed technical difficulties with continuous interscalene block in 9-44% of adult cases. Recently, Capdevila et al…”

Interscalene Brachial Plexus Block with Continues Catheter Insertion System and a Disposable Infusion Pump in Patients Undergoing Surgery for Fracture Head of Humerus by open Reduction and Internal Fixation

“…In addition, initial interscalene blockade was successful in all patients and all catheters were functional after 24 h with the continuous catheter insertion system. The authors concluded that it is possible to achieve a high rate of successful catheter placement and analgesia by using the continuous catheter insertion system and a disposable infusion pump in the ambulatory setting [11] . Ilfeld BM et al conducted a study to determine if the basal rate of an Interscalene perineural ropivacaine infusion could be decreased by 50% with a concurrent 200% increase in patientcontrolled bolus dose without compromising infusion benefits in ambulatory patients undergoing moderately painful orthopedic shoulder surgery.…”

“…Despite these limitations many randomized controlled trials have demonstrated that use of Interscalene brachial plexus block with continuous catheter insertion system and disposable infusion pump is associated with better analgesic effect, reduced requirement of opioid analgesics and overall feeling of improvement in patients undergoing shoulder surgeries [7] . Popularity of this technique is increasing with point of care ultrasound (POCUS) using high frequency probes (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). With the use of ultrasound imaging excellent gray scale images of brachial plexus and its trunks, cords and divisions can be well demonstrated which consequently greatly improve accuracy with which perineural catheter is placed.…”

Pain Management Strategies in Hand Surgery

“…Catheter patency or secondary catheter block has been identified in many studies as a major mode of failure of CPNB with rates ranging from 10%-20% [59][60][61] 63 , fluid leakage at the catheter site 59 and dislodgement or obstruction of the tubing 64 . Incorrect catheter placement 65 , despite the significant increase in placement accuracy with the use of ultrasound guidance, also still remains an issue.…”