The effect of continuous interscalene brachial plexus block with 0.125% bupivacaine vs 0.2% ropivacaine on pain relief, diaphragmatic motility, and ventilatory function

Choromanski, Dominik; Patel, Pranav; Frederick, Joel M.; Lemos, Stephen; Chidiac, Elie Joseph

doi:10.1016/j.jclinane.2015.03.006

Cited by 20 publications

(11 citation statements)

References 41 publications

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“…With a vasoconstrictive effect at low concentration (0.063-0.5%) 34 , ropivacaine is often not used with epinephrine 7 which also has an unpredictable role in the cardiovascular system. The concentrations of ropivacaine in this study were chosen to be 0.2%, 0.33%, 0.5% based on the findings that scalp infiltration by 0.5% ropivacaine reduced postoperative pain received craniotomy in previous study 17 and 0.2%, 0.33% ropivacaine are usually preferred for peripheral nerve block procedures [35][36][37] . In our study, pre-incision SNB with 0.2% and 0.33% ropivacaine decreased the postoperative pain for up to 2 hours, and 0.5% ropivacaine used as postoperative analgesia had longer duration for up to 4 hours after craniotomy.…”

Section: Discussionmentioning

confidence: 99%

Effect of Scalp Nerve Block with Ropivacaine on Postoperative Pain in Patients Undergoing Craniotomy: A Randomized, Double Blinded Study

Yang

Zhou

et al. 2020

Sci Rep

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Scalp nerve block with ropivacaine has been shown to provide perioperative analgesia. However, the best concentration of ropivacaine is still unknown for optimal analgesic effects. We performed a prospective study to evaluate the effects of scalp nerve block with varied concentration of ropivacaine on postoperative pain and intraoperative hemodynamic variables in patients undergoing craniotomy under general anesthesia. Eighty-five patients were randomly assigned to receive scalp block with either 0.2% ropivacaine, 0.33% ropivacaine, 0.5% ropivacaine, or normal saline. Intraoperative hemodynamics and post-operative pain scores at 2, 4, 6, 24 hours postoperatively were recorded. We found that scalp blockage with 0.2% and 0.33% ropivacaine provided adequate postoperative pain relief up to 2 h, while administration of 0.5% ropivacaine had a longer duration of action (up to 4 hour after craniotomy). Scalp nerve block with varied concentration of ropivacaine blunted the increase of mean arterial pressure in response to noxious stimuli during incision, drilling, and sawing skull bone. 0.2% and 0.5% ropivacaine decreased heart rate response to incision and drilling. We concluded that scalp block using 0.5% ropivacaine obtain preferable postoperative analgesia compared to lower concentrations. And scalp block with ropivacaine also reduced hemodynamic fluctuations in craniotomy operations. About 10% to 20% patients undergoing craniotomy suffered severe pain and more than 30% experienced moderate pain as per Guilfoyle et al. 1. These experiences with pain may disturb patient sleep patterns and prolong hospital stays 2. Abrupt increases in heart rate (HR) and blood pressure (BP) resulting from dramatic stimuli like incisions, drilling, and screwing cause potential morbidities and mortalities due to elevation of intracranial pressure (ICP) in patients 3,4. Generally, opioids are used for relieving hemodynamic fluctuations and reducing postoperative pain, however, it may delay recovery time, contribute to extreme sedation, and interfere with postoperative neurological examinations. In addition, adverse effects of opioids such as nausea and vomiting, and respiratory depression may result in a rise of ICP or mask the signs of increased ICP. Since there is such an emphasis on controlling the adverse effects of opioid administration, postoperative pain after craniotomy is frequently uncontrolled 1. Easing hemodynamic perturbation and relieving postoperative pain are important concerns of neuroanesthesiologists and are also necessary components of the Enhanced Recovery After Surgery (ERAS). With advances in modern anesthesia come the development of short-acting analgesics, mainly remifentanil, transition analgesics, and conjunction analgesics that can be used instead of opioids to treat postoperative pain 5. Scalp never block (SNB), the blockage of nerves that innervate the involved region of the scalp about surgery 6 , was developed due to its potential benefits for effective regional anesthesia administration 7 , which promotes d...

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Section: Discussionmentioning

confidence: 99%

Effect of Scalp Nerve Block with Ropivacaine on Postoperative Pain in Patients Undergoing Craniotomy: A Randomized, Double Blinded Study

Yang

Zhou

et al. 2020

Sci Rep

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“… 35 2014 Low Low High Low Low Low Bjørnholdt et al 36 2014 Unclear Low High Low Low Low Cabaton et al. 37 2019 Low Low High High Low Low Choromanski et al 38 2015 Low Low Low Low Low Low Cho et al 39 2011 Low High High High Unclear High Cogan et al. 40 2020 Low Low High Low Low High DeMarco et al 41 2011 Low Low High Low Low Low Espelund et al 42 2014 Low Low ...…”

Section: Resultsmentioning

confidence: 99%

Postoperative Multimodal Pain Management and Opioid Consumption in Arthroscopy Clinical Trials: A Systematic Review

Paul

Szukics

Brutico

et al. 2022

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To provide an updated review of multimodal pain management in arthroscopic surgery by evaluating pain and opioid consumption after shoulder, knee, and hip arthroscopy. Methods: A comprehensive literature search was performed to identify randomized controlled trials (RCTs) investigating multimodal pain management after shoulder, knee, and hip arthroscopy. Articles were identified from January 2011 through December 2020 using various databases. As the primary outcome variables of this study, differences in postoperative pain and opioid consumption volumes were summarized from all reported postoperative time points. Results: 37 shoulder, 28 knee, and 8 hip arthroscopy RCTs were included in the study. The most frequent bias present in the included RCTs was incomplete outcome data (58%), while group allocation concealment was the least frequent bias (15%). Qualitative analysis of rotator cuff repair (n ¼ 12), anterior cruciate ligament reconstruction (n ¼ 11), meniscectomy (n ¼ 5), femoroacetabular impingement (n ¼ 2), oral medications (n ¼ 8), postoperative interventions (n ¼ 10), and nonpharmacological interventions (n ¼ 6) was performed. Conclusions: Many multimodal pain management protocols offer improved pain control and decreased opioid consumption after arthroscopic surgery. On the basis of the current literature, the evidence supports an interscalene nerve block with a dexamethasone-dexmedetomidine combination for rotator cuff repair, a proximal continuous adductor canal block for anterior cruciate ligament reconstruction, and local infiltration analgesia (e.g., periacetabular injection with 20 mL of .5% bupivacaine) for hip arthroscopy. When evaluating oral medication, the evidence supports 150 mg Pregabalin for shoulder arthroscopy, 400 mg Celecoxib for knee arthroscopy, and 200 mg Celecoxib for hip arthroscopy, all taken preoperatively. There is promising evidence for the use of various nonpharmacological modalities, specifically preoperative opioid education for rotator cuff repair patients; however, more clinical trials that evaluate nonpharmacological interventions should be performed.

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“…The most common adverse event during cIBPB was phrenic nerve block. The distance between the brachial plexus and the phrenic nerve is 0.18 cm at the C5–C6 level 27 and the C3–C5 roots are the origin for the phrenic nerve. 28 The diaphragm is the main breathing muscle and is innervated by the phrenic nerve.…”

Section: Discussionmentioning

confidence: 99%

“… 29 , 34 , 35 This is because the compensation by the contralateral diaphragm, intercostal, and abdominal muscles can counteract the functional impact of ipsilateral hemidiaphragmatic paresis. 27 , 30–32 Additionally, hemidiaphragmatic contraction reportedly accounts for only up to 30% of total minute ventilation at rest. 34 In our study, most of the patients did not experience a feeling of tachypnoea.…”

Section: Discussionmentioning

confidence: 99%

Effects of Different 0.2% Ropivacaine Infusion Regimens for Continuous Interscalene Brachial Plexus Block on Postoperative Analgesia and Respiratory Function After Shoulder Arthroscopic Surgery: A Randomized Clinical Trial

Ye¹,

Wang²,

Zhang³

et al. 2022

JPR

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Objective Continuous interscalene brachial plexus block (cIBPB) is an effective perioperative analgesic therapy for shoulder arthroscopic surgery (SAS) patients. This trial aimed to compare the effect of different cIBPB infusion methods on postoperative analgesia and respiratory function in patients undergoing SAS. Methods After SAS, 88 patients were randomly assigned to four groups. Through interscalene catheter, all the patients received an initial dose of 10 mL 0.2% ropivacaine. The CI group received 0.2% ropivacaine 4 mL/h, and the PIBI1, PIBI2, and PIBI3 groups received intermittent 0.2% ropivacaine boluses at 4 mL/h, 8 mL/2 h, and 12 mL/3 h, respectively. The patients could also use a patient-controlled analgesia (PCA) pump to self-inject a tramadol bolus each time he/she felt pain. The primary outcome was the cumulative tramadol consumption over the 48 h after surgery. Secondary outcome measures included PCA frequency, pain (visual analogue scale, VAS) score, patient satisfaction, diaphragmatic excursion, pulmonary function, and adverse events. Results The cumulative tramadol consumption and PCA frequency over the 48 h after surgery in groups PIBI2 and PIBI3 were lower than in both the CI and PIBI1 groups ( p <0.001). The VAS scores (at rest and on movement) in groups PIBI2 and PIBI3 were lower than those in the CI and PIBI1 groups at 8 and 12 h after surgery (all p <0.001). Patient satisfaction scores were significantly higher in the PIBI2 group than in the other three groups (all p <0.001). Diaphragmatic excursion was significantly decreased in the PIBI3 group compared to the other three groups ( p <0.05). The incidence of adverse events over the 48 h after surgery was significantly higher in the PIBI3 group compared to the other three groups ( p <0.001). Conclusion Programmed intermittent bolus infusion with 0.2% ropivacaine 8 mL/2 h for cIBPB can achieve lower tramadol consumption, along with better analgesia after surgery, lower reduction in diaphragmatic excursion, lower incidence of adverse events, and higher patient satisfaction.

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The effect of continuous interscalene brachial plexus block with 0.125% bupivacaine vs 0.2% ropivacaine on pain relief, diaphragmatic motility, and ventilatory function

Cited by 20 publications

References 41 publications

Effect of Scalp Nerve Block with Ropivacaine on Postoperative Pain in Patients Undergoing Craniotomy: A Randomized, Double Blinded Study

Effect of Scalp Nerve Block with Ropivacaine on Postoperative Pain in Patients Undergoing Craniotomy: A Randomized, Double Blinded Study

Postoperative Multimodal Pain Management and Opioid Consumption in Arthroscopy Clinical Trials: A Systematic Review

Effects of Different 0.2% Ropivacaine Infusion Regimens for Continuous Interscalene Brachial Plexus Block on Postoperative Analgesia and Respiratory Function After Shoulder Arthroscopic Surgery: A Randomized Clinical Trial

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