Postoperative Analgesia in a Prolonged Continuous Interscalene Block Versus Single-Shot Block in Outpatient Arthroscopic Rotator Cuff Repair: A Prospective Randomized Study.Arthroscopy. 2016 08; 32(8):1544-1550.e1.A
To compare the analgesic efficacy of 3-day continuous interscalene brachial plexus block versus a single-shot block for arthroscopic rotator cuff repair.
Eighty-five patients scheduled for arthroscopic rotator cuff repair were randomly assigned to either the single-shot group (SSG) or continuous interscalene brachial block group (CG). Patients in the SSG received 2.5 mg/kg of 0.5% bupivacaine up to 25 mL; the CG received the same dose as a loading dose via catheter followed by an infusion of 0.125% bupivacaine at 5 mL/h and a patient-controlled bolus of 5 mL hourly for 72 hours. Follow-up after discharge was with telephone calls over the next 3 days. Pain was measured on a visual analog scale. Also measured were sleep disturbance, number of opioid doses taken, adverse effects, and level of patient satisfaction.
The median rest pain scores on the 3 days of follow-up measured on a scale of 0 to 10 (with 10 equal to greatest pain) were 0, 0, and 3 in the CG compared with 4, 4, and 3 in the SSG (P < .001) for days 1, 2, and 3, respectively. The median maximum scores were 2, 2, and 4 in the CG compared with 8, 7, and 6 in the SSG (P < .001) for the same time period.
A 3-day continuous interscalene brachial plexus block provides better analgesia than a single-shot block. Sleep patterns were better, and less opioid was needed after arthroscopic rotator cuff repair in patients given a continuous plexus block.
LEVEL OF EVIDENCE
Level I, prospective randomized study.