Interscalene perineural ropivacaine infusion:a comparison of two dosing regimens for postoperative analgesia

Morey, Timothy E.; Wright, Thomas W.; Chidgey, Larry K.; Enneking, F. Kayser

doi:10.1016/j.rapm.2003.08.016

Cited by 53 publications

(53 citation statements)

References 27 publications

(19 reference statements)

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“…Patients and their carers should be given extensive oral and written instructions about management, side effects and care of the local anaesthetic catheter, and have 24-hour a day telephone access to an anaesthesiologist during the postoperative period while CNPB is in use (Swenson et al, 2006), as 30% of patients make unscheduled phone calls regarding catheter infusions despite been given adequate written and verbal instructions Level II). A review of 620 outpatients with CPNB (including popliteal fossa, fascia iliaca and interscalene) showed that 4.2% required assistance by the anaesthesiologist after discharge from hospital for problems relating to issues such as patient education, inadequate analgesia and equipment malfunction; only one patient was unable to remove their catheter (Swenson et al, 2006 Level IV), although patients may have significant anxiety about catheter removal at home (Ilfeld et al, 2004 Level IV).…”

Section: Level Ii)mentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor‐blinded, equivalence and non‐inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10‐point verbal numerical rating scale (VNRS) of at least 4. Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units. Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non‐inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention‐to‐treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between‐group differences. Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

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Section: Level Ii)mentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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“…CISB for shoulder surgery provides better analgesia than placebo or systemic opioids do and is associated with less opioid consumption and fewer opioid-related side effects. 184,[209][210][211][212][213] CISB with perineural infusion of local anesthetic has been shown to benefit patient rehabilitation 214 and can be continued at home with a portable infusion pump. 215 In a randomized controlled study, Ilfeld and colleagues 166 showed that ambulatory CISB with perineural infusion of 0.2% ropivacaine decreased the time until readiness for discharge after total shoulder arthroplasty by allowing good shoulder range of motion and providing adequate pain control without parenteral opioids.…”

Section: Interscalene Blockmentioning

confidence: 99%

Postoperative Pain and Other Acute Pain Syndromes

Hanna

Ouanes

Tomas

2014

Practical Management of Pain

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“…One uses a stimulating catheter, which is described in greater detail elsewhere [49,50]. Here we describe a technique using a non-stimulating catheter.…”

Section: Needlementioning

confidence: 99%

“…For continuous infusion, bupivacaine 0.125%, levobupivacaine 0.125% or ropivacaine 0.2% may be used, with an infusion regimen of 8 ml/hr and 2 ml boluses once per hour [49]. The interested reader is referred to additional references for more detailed information on ambulatory catheters and local anesthetic infusion modes [49,52].…”

Section: Local Anesthetics and Additivesmentioning

confidence: 99%

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Anesthesia for Shoulder Surgery: A Review of the Interscalene Block and a Discussion of Regional vs. General Anesthesia

Ghaleb¹,

Dilley²

2012

TOATJ

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A review of the literature regarding anesthesia for shoulder surgery was performed. Current anesthetic techniques available include regional, general, or a combination of regional and general. We discuss each of these techniques, with an emphasis on regional (specifically interscalene block), in detail. Current evidence supports both regional and general anesthesia to be safe and efficient techniques. The interscalene block is considered by most to provide the best surgical anesthesia and is the most commonly performed block for shoulder surgery. This paper aims to review the performance of the interscalene block and to discuss alternative choices for shoulder surgery, namely general anesthesia and a combined general/regional technique. We also aim to provide considerations to aid in the performance of a safely administered anesthetic.

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Interscalene perineural ropivacaine infusion:a comparison of two dosing regimens for postoperative analgesia

Abstract: Following moderately painful ambulatory shoulder surgery, decreasing an interscalene perineural ropivacaine 0.2% basal rate from 8 to 4 mL/h provides similar baseline analgesia and lengthens infusion duration, but compromises other infusion benefits.

Cited by 53 publications

References 27 publications

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Postoperative Pain and Other Acute Pain Syndromes

Anesthesia for Shoulder Surgery: A Review of the Interscalene Block and a Discussion of Regional vs. General Anesthesia

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