Local infiltration analgesia versus continuous interscalene brachial plexus block for shoulder replacement pain: a randomized clinical trial

Bjørnholdt, Karen Toftdahl; Jensen, Jan Mick; Bendtsen, Thomas Fichtner; Søballe, Kjeld; Nikolajsen, Lone

doi:10.1007/s00590-015-1678-2

Cited by 49 publications

(37 citation statements)

References 33 publications

(34 reference statements)

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“…In most cases, the activity was lower than when using the systemic approach. 19 This is in line with previous findings in pigs. When treating the animals with systemic administration of morphine, 16 there is a complete block of the animal’s sensitivity to tactile stimuli using the von Frey filaments.…”

Section: Discussionsupporting

confidence: 93%

The effect of local/topical analgesics on incisional pain in a pig model

Castel¹,

Sabbag²,

Meilin³

2017

JPR

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Interest in the development of new topical/local drug administration for blocking pain at peripheral sites, with maximum drug activity and minimal systemic effects, is on the rise. In the review article by Kopsky and Stahl, four critical barriers in the process of research and development of topical analgesics were indicated. The active pharmaceutical ingredient (API) and the formulation are among the major challenges. The road to the development of such drugs passes through preclinical studies. These studies, if planned correctly, should serve as guidance for choosing the right API and formulation. Although rodent models for pain continue to provide valuable data on the mechanisms driving pain, their use in developing topical and localized treatment approaches is limited for technical (intraplate injection area is small) as well as mechanical reasons (non-similarity to human skin and innervation). It has been previously shown that pigs are comparable to humans in ways that make them a better choice for evaluating topical and local analgesics. The aim of this study was to summarize several experiments that used pigs for testing postoperative pain in an incisional pain model (skin incision [SI] and skin and muscle incision [SMI]). At the end of the surgery, the animals were treated with different doses of bupivacaine solution (Marcaine®), bupivacaine liposomal formulation (Exparel®) or ropivacaine solution (Naropin). Von Frey testing demonstrated a decrease in the animals’ sensitivity to mechanical stimulation expressed as an increase in the withdrawal force following local treatment. These changes reflect the clinical condition in the level as well as in the duration of the response. These data indicate a good resemblance between pig and human skin and suggest that use of these animals in the preclinical phase of developing topical analgesics can, to some extent, release the bottleneck.

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Section: Discussionsupporting

confidence: 93%

The effect of local/topical analgesics on incisional pain in a pig model

Castel¹,

Sabbag²,

Meilin³

2017

JPR

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“…However, the duration of analgesia is directly related to local anesthetic duration time 9 and rescue analgesic medication is often necessary for postoperative analgesia, coincidently on second postoperative day. 10 The regional block technique was probably superior to systemic analgesia in this type of surgery, mostly on early postoperative period and patients who received no continuous analgesia had higher pain scores on the second and third postoperative day.…”

Section: Discussionmentioning

confidence: 91%

Prospective study of ultrasound-guided peri-plexus interscalene block with continuous infusion catheter for arthroscopic rotator cuff repair and postoperative pain control

Gomide¹,

Ruzi²,

Mandim

et al. 2018

Revista Brasileira de Ortopedia (English Edition)

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ObjectiveThis trial investigated postoperative analgesia in arthroscopic rotator cuff repair surgery patients under general anesthesia, associated with ultrasound-guided peri-plexus interscalene brachial plexus block (US-IBPB), and compared single injection to elastomeric pump continuous infusion of local anesthetics. Complications associated to both techniques are described.MethodsIn this prospective, quasi-randomized controlled clinical trial, 68 adults scheduled for elective arthroscopic rotator cuff repair were assigned to receive Group 1 (G1 = 41) US-IBPB with a 20 mL injection of 0.5% peri-plexus ropivacaine, introduction of catheter, injection of 20 mL of 0.5% ropivacaine through continuous catheter infusion of local anesthetic by elastomeric pump (ropivacaine 0.2%, infusion of 5 mL/h). In Group 2 (G2 = 27), US-IBPB, with a single peri-plexus injection of 40 mL ropivacaine 0.5%. In both groups oral analgesics were prescribed, paracetamol 500 mg associated to codeine 30 mg for patients with VAS between 3 and 5, and also oxycodone 20 mg for VAS ≥ 6. The anesthesiology team was available through contact telephones and the patients received a table to complete in order to report pain intensity according to VAS, use of oral medication, and complications related to the catheter and pump, until the third postoperative day.ResultsThe intensity of pain was higher on second day after surgery than on days 1 and 3, in both groups confirmed by the ANOVA test (p = 0.00006) Among the groups, G1 patients had lower pain intensity than G2, (p = 0.000197). G2 patients presented greater pain intensity during all periods studied (days 1, 2, and 3) than G1 patients. Postoperatively, G2 patients had higher consumption of rescue analgesics, nausea, and vomiting (40.74%) vs. G1 (5%) and dizziness (25.92%). No patient with catheter and elastomeric pump (G1) had complications regarding its insertion and maintenance during postoperative period.ConclusionThe quality of analgesia for arthroscopic rotator cuff repair with peri-plexus US-IBPB and continuous infusion with elastomeric pump presented superior postoperative analgesia quality to single puncture IBPB on postoperative days 2 and 3, with lower consumption of rescue opioids in this period.

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“…Our results support this theory, as application at a higher supraclavicular level resulted in a superior analgesic effect than that previously reported , although this benefit was only seen on the day of surgery. During the period from 20 to 36 h after surgery, several patients lost or displaced their nerve catheter (which is a well‐described complication to nerve catheters in this anatomical area ) and the pain scores in both groups were rather low. Based on this, we believe that phrenic nerve block via a nerve catheter is only necessary for a subset of patients with ongoing, intense ipsilateral shoulder pain that is refractory to pharmacological treatment.…”

Section: Discussionmentioning

confidence: 99%

A randomised, controlled, double-blind trial of ultrasound-guided phrenic nerve block to prevent shoulder pain after thoracic surgery

et al. 2016

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Moderate to severe ipsilateral shoulder pain is a common complaint following thoracic surgery. In this prospective, parallel-group study at Odense University Hospital, 76 patients (aged > 18 years) scheduled for lobectomy or pneumonectomy were randomised 1:1 using a computer-generated list to receive an ultrasound-guided supraclavicular phrenic nerve block with 10 ml ropivacaine or 10 ml saline (placebo) immediately following surgery. A nerve catheter was subsequently inserted and treatment continued for 3 days. The study drug was pharmaceutically pre-packed in sequentially numbered identical vials assuring that all participants, healthcare providers and data collectors were blinded. The primary outcome was the incidence of unilateral shoulder pain within the first 6 h after surgery. Pain was evaluated using a numeric rating scale. Nine of 38 patients in the ropivacaine group and 26 of 38 patients in the placebo group experienced shoulder pain during the first 6 h after surgery (absolute risk reduction 44% (95% CI 22-67%), relative risk reduction 65% (95% CI 41-80%); p = 0.00009). No major complications, including respiratory compromise or nerve injury, were observed. We conclude that ultrasound-guided supraclavicular phrenic nerve block is an effective technique for reducing the incidence of ipsilateral shoulder pain after thoracic surgery.

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Local infiltration analgesia versus continuous interscalene brachial plexus block for shoulder replacement pain: a randomized clinical trial

Abstract: The LIA technique cannot be recommended for shoulder replacement unless substantially modified. Occurrence of inadequate analgesia and complications following interscalene brachial plexus block prompt further studies into pain management after shoulder replacement.

Cited by 49 publications

References 33 publications

The effect of local/topical analgesics on incisional pain in a pig model

The effect of local/topical analgesics on incisional pain in a pig model

Prospective study of ultrasound-guided peri-plexus interscalene block with continuous infusion catheter for arthroscopic rotator cuff repair and postoperative pain control

A randomised, controlled, double-blind trial of ultrasound-guided phrenic nerve block to prevent shoulder pain after thoracic surgery

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