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

Abstract

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.

Use of Opioids in the Early Postoperative Period After Arthroscopic Rotator Cuff Repair: A Systematic Review

“…Regional NBs, particularly interscalene brachial plexus blocks, have been well-documented methods to reduce postoperative pain and opioid requirements in patients undergoing ARCR. 17 , 23 , 26 , 29 , 38 , 50 The results of our systematic review confirm that placement of NBs significantly reduces opioid requirements in the first 24 hours after surgery. While there are pharmacokinetic and pharmacodynamic differences between the various long-acting anesthetics used in brachial plexus NBs, there is no clear evidence demonstrating superiority in terms of reducing postoperative VAS scores and opioid requirements.…”

PROSPECT guideline for rotator cuff repair surgery: systematic review and procedure‐specific postoperative pain management recommendations

“…Gomide et al. compared continuous interscalene block with single‐shot interscalene block and found that the continuous interscalene block group had significantly lower pain scores and rescue analgesic consumption on POD 1, 2 and 3. Kim et al.…”

A Retrospective Comparison of Interscalene Continuous Catheter Verse Single-Injection with Liposomal Bupivacaine in Total Shoulder Arthroplasty

“…The ISB is a well-established, regularly utilized, regional technique that provides excellent perioperative pain control in Total Shoulder Arthroplasty (TSA) [7] [8]. Furthermore, extending that pain control over a longer period post operatively with a catheter provides additional benefits as has been borne out in previous studies [9] [10] [11] [12]. TSA has progressively increased in frequency in both the inpatient and ambulatory settings [13].…”