Ultrasound-Guided Continuous Interscalene Block

Hamdani, Mehdi; Chassot, Olivier; Fournier, Roxane

doi:10.1097/aap.0000000000000112

Cited by 24 publications

(3 citation statements)

References 27 publications

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“…16 While the current investigation did compare repeated large (24 mL) bolus volumes with a steady basal infusion of 8 mL/h, the mass of ropivacaine administered was equivalent at Hours 3 and 6. Supporting this theory are three negative studies comparing a basal infusion and repeated bolus doses of equivalent local anesthetic mass for interscalene, 22 femoral, 21 and adductor canal 23 catheters.…”

Section: Discussionmentioning

confidence: 94%

Continuous Transversus Abdominis Plane Nerve Blocks: Does Varying Local Anesthetic Delivery Method—Automatic Repeated Bolus Versus Continuous Basal Infusion—Influence the Extent of Sensation to Cold?: A Randomized, Triple-Masked, Crossover Study in Volunteers

Khatibi

Said

Sztain

et al. 2017

Anesthesia &Amp; Analgesia

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Background It remains unknown whether continuous or scheduled intermittent bolus local anesthetic administration is preferable for transversus abdominis plane (TAP) catheters. We therefore tested the hypothesis that when using TAP catheters, providing local anesthetic in repeated bolus doses increases the cephalad-caudad cutaneous effects compared with a basal-only infusion. Methods Bilateral TAP catheters (posterior approach) were inserted in 24 healthy volunteers followed by ropivacaine 2 mg/mL administration for a total of 6 hours. The right side was randomly assigned to either a basal infusion (8 mL/h) or bolus doses (24 mL administered every 3 hours for a total of 2 bolus doses) in a double-masked manner. The left side received the alternate treatment. The primary endpoint was the extent of sensory deficit as measured by cool roller along the axillary line at Hour 6 (6 hours after the local anesthetic administration was initiated). Secondary endpoints included the extent of sensory deficit as measured by cool roller and Von Frey filaments along the axillary line and along a transverse line at the level of the anterior superior iliac spine at Hours 0–6. Results While there were statistically significant differences between treatments within the earlier part of the administration period, by Hour 6 the difference in extent of sensory deficit to cold failed to reach statistical significance along the axillary line (mean=0.9 cm; SD=6.8; 95% CI −2.0, 3.8; p=0.515) and transverse line (mean=2.5 cm; SD=10.1; 95% CI −1.8, 6.8; p=0.244). While the difference between treatments was statistically significant at various early time points for the horizontal, vertical and estimated area measurements of both cold and mechanical pressure sensory deficits, no comparison remained statistically significant by Hour 6. Conclusion No evidence was found in this study involving healthy volunteers to support the hypothesis that changing the local anesthetic administration technique (continuous basal versus hourly bolus) when using ropivacaine 0.2% and TAP catheter at 8 mL/h and 24 mL every 3 hours significantly influences the cutaneous effects after 6 hours of administration. Additional research is required to determine whether changing variables (e.g., local anesthetic concentration, basal infusion rate, bolus dose volume and/or interval) would provide different results.

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Section: Discussionmentioning

confidence: 94%

Continuous Transversus Abdominis Plane Nerve Blocks: Does Varying Local Anesthetic Delivery Method—Automatic Repeated Bolus Versus Continuous Basal Infusion—Influence the Extent of Sensation to Cold?: A Randomized, Triple-Masked, Crossover Study in Volunteers

Khatibi

Said

Sztain

et al. 2017

Anesthesia &Amp; Analgesia

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“…Because ambulatory patients are discharged with a set reservoir volume that rarely exceeds 500 mL owing to weight and bulk limitations, the only way to extend analgesia duration is by decreasing local anesthetic consumption [ 1 ]. The results of studies comparing automated boluses with continuous infusions have been mixed, with results varying from significant to no benefit in the analgesia provided [ 1 – 3 , 9 – 11 ]. However, previous studies comparing automated boluses with continuous infusions for continuous peripheral nerve blocks have largely used the same basal dosing in both groups (e.g., 5 mL/h of continuous infusion compared with 5 mL of bolus every hour) [ 2 , 3 , 9 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…The results of studies comparing automated boluses with continuous infusions have been mixed, with results varying from significant to no benefit in the analgesia provided [ 1 – 3 , 9 – 11 ]. However, previous studies comparing automated boluses with continuous infusions for continuous peripheral nerve blocks have largely used the same basal dosing in both groups (e.g., 5 mL/h of continuous infusion compared with 5 mL of bolus every hour) [ 2 , 3 , 9 , 11 ]. Because long-acting local anesthetics are generally used for cPNB [ 1 ], longer intervals between boluses might further lengthen the analgesic duration.…”

Section: Discussionmentioning

confidence: 99%

Automated Boluses and Delayed-Start Timers Prolong Perineural Local Anesthetic Infusions and Analgesia Following Ankle and Wrist Orthopedic Surgery: A Case-Control Series

et al. 2021

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Background Continuous peripheral nerve blocks can be administered as continuous infusion, patient-controlled boluses, automated boluses, or a combination of these modalities. Material/Methods Ten patients undergoing either ankle (5) or distal radius (5) open reduction and internal fixation received single-injection ropivacaine sciatic nerve block or infraclavicular brachial plexus block and catheter. Infusion pumps were set to begin administering additional ropivacaine 6 h following the initial block as automated boluses supplemented with patient-controlled boluses. Results Patients had similar pain scores when compared to previously published controls; however, local anesthetic consumption was lower in the patients, resulting in increased infusion and analgesia duration by 1 or more days in each group. Conclusions For infraclavicular and popliteal sciatic catheters, automated boluses may provide a longer duration of analgesia than continuous infusions following painful hand and ankle surgeries, respectively.

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Continuous Peripheral Nerve Blocks

Ilfeld¹,

Mariano²

2018

Essentials of Pain Medicine

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Ultrasound-Guided Continuous Interscalene Block

Cited by 24 publications

References 27 publications

Continuous Transversus Abdominis Plane Nerve Blocks: Does Varying Local Anesthetic Delivery Method—Automatic Repeated Bolus Versus Continuous Basal Infusion—Influence the Extent of Sensation to Cold?: A Randomized, Triple-Masked, Crossover Study in Volunteers

Continuous Transversus Abdominis Plane Nerve Blocks: Does Varying Local Anesthetic Delivery Method—Automatic Repeated Bolus Versus Continuous Basal Infusion—Influence the Extent of Sensation to Cold?: A Randomized, Triple-Masked, Crossover Study in Volunteers

Automated Boluses and Delayed-Start Timers Prolong Perineural Local Anesthetic Infusions and Analgesia Following Ankle and Wrist Orthopedic Surgery: A Case-Control Series

Continuous Peripheral Nerve Blocks

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