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Interscalene brachial plexus bolus block versus patient-controlled interscalene indwelling catheter analgesia for the first 48 hours after arthroscopic rotator cuff repair.
J Shoulder Elbow Surg. 2018 Jul; 27(7):1243-1250.JS

Abstract

BACKGROUND

We sought to compare the efficacy of interscalene brachial plexus bolus blockade (IBPBB) and patient-controlled interscalene indwelling catheter analgesia (PCIA) for postoperative pain management within 48 hours postoperatively in patients undergoing arthroscopic rotator cuff repairs (ARCR).

METHODS

Patients undergoing ARCR were randomized into 3 groups by postoperative analgesia method. The IBPBB group received a mixed solution of 16 mL of 0.75% ropivacaine and 4 mL of 2% lidocaine as a bolus postoperatively. The PCIA group received a 10-mL bolus solution of 0.75% ropivacaine (4 mL) and 5% dextrose water (6 mL) just after the operation and continuous infusion of this solution. The control received only meperidine as needed, 12.5 mg, intravenously. Visual analog scale (VAS) pain scores were evaluated for the first 48 hours postoperatively.

RESULTS

For the first 2 hours postoperatively, VAS scores in the IBPBB group were significantly lower than in the PCIA group and control group, but at 12 and 24 hours postoperatively, VAS scores of the IBPBB group were significantly higher than the PCIA group (P < .05). At 48 hours postoperatively, there was no significant difference in VAS scores among the 3 groups (P = .169). The method of analgesia was the only factor affecting pain scores at 24 hours postoperatively (P < .05).

CONCLUSIONS

IBPBB provided effective immediate postoperative analgesia until 6 hours postoperatively. Especially until postoperative 2 hours, the VAS pain score was less than 1 point in the IBPBB group; however, there was significant rebound pain at 12 hours after surgery. During the first 24 hours postoperatively, PCIA reduced postoperative pain without rebound pain. Surgeons should choose methods for control of postoperative pain considering the advantages and disadvantages of each analgesic method.

Authors+Show Affiliations

Department of Orthopedic Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea.Departiment of Anesthesiology and Pain, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea.Departiment of Anesthesiology and Pain, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea.Department of Orthopedic Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea.Department of Orthopedic Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea.Department of Orthopedic Surgery, Seoul Nanuri Hospital, Seoul, Republic of Korea.Department of Orthopedic Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea. Electronic address: kysoos@catholic.ac.kr.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

29605659

Citation

Kim, Jong-Ho, et al. "Interscalene Brachial Plexus Bolus Block Versus Patient-controlled Interscalene Indwelling Catheter Analgesia for the First 48 Hours After Arthroscopic Rotator Cuff Repair." Journal of Shoulder and Elbow Surgery, vol. 27, no. 7, 2018, pp. 1243-1250.
Kim JH, Koh HJ, Kim DK, et al. Interscalene brachial plexus bolus block versus patient-controlled interscalene indwelling catheter analgesia for the first 48 hours after arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2018;27(7):1243-1250.
Kim, J. H., Koh, H. J., Kim, D. K., Lee, H. J., Kwon, K. H., Lee, K. Y., & Kim, Y. S. (2018). Interscalene brachial plexus bolus block versus patient-controlled interscalene indwelling catheter analgesia for the first 48 hours after arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery, 27(7), 1243-1250. https://doi.org/10.1016/j.jse.2018.02.048
Kim JH, et al. Interscalene Brachial Plexus Bolus Block Versus Patient-controlled Interscalene Indwelling Catheter Analgesia for the First 48 Hours After Arthroscopic Rotator Cuff Repair. J Shoulder Elbow Surg. 2018;27(7):1243-1250. PubMed PMID: 29605659.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Interscalene brachial plexus bolus block versus patient-controlled interscalene indwelling catheter analgesia for the first 48 hours after arthroscopic rotator cuff repair. AU - Kim,Jong-Ho, AU - Koh,Hyun Jung, AU - Kim,Dong Kyu, AU - Lee,Hyo-Jin, AU - Kwon,Ki-Hyun, AU - Lee,Kwang-Yeol, AU - Kim,Yang-Soo, Y1 - 2018/03/29/ PY - 2017/12/02/received PY - 2018/02/01/revised PY - 2018/02/13/accepted PY - 2018/4/2/pubmed PY - 2018/10/12/medline PY - 2018/4/2/entrez KW - Rotator cuff repair KW - brachial plexus KW - interscalene bloc KW - pain management KW - postoperative pain KW - regional nerve block KW - shoulder arthroscopy SP - 1243 EP - 1250 JF - Journal of shoulder and elbow surgery JO - J Shoulder Elbow Surg VL - 27 IS - 7 N2 - BACKGROUND: We sought to compare the efficacy of interscalene brachial plexus bolus blockade (IBPBB) and patient-controlled interscalene indwelling catheter analgesia (PCIA) for postoperative pain management within 48 hours postoperatively in patients undergoing arthroscopic rotator cuff repairs (ARCR). METHODS: Patients undergoing ARCR were randomized into 3 groups by postoperative analgesia method. The IBPBB group received a mixed solution of 16 mL of 0.75% ropivacaine and 4 mL of 2% lidocaine as a bolus postoperatively. The PCIA group received a 10-mL bolus solution of 0.75% ropivacaine (4 mL) and 5% dextrose water (6 mL) just after the operation and continuous infusion of this solution. The control received only meperidine as needed, 12.5 mg, intravenously. Visual analog scale (VAS) pain scores were evaluated for the first 48 hours postoperatively. RESULTS: For the first 2 hours postoperatively, VAS scores in the IBPBB group were significantly lower than in the PCIA group and control group, but at 12 and 24 hours postoperatively, VAS scores of the IBPBB group were significantly higher than the PCIA group (P < .05). At 48 hours postoperatively, there was no significant difference in VAS scores among the 3 groups (P = .169). The method of analgesia was the only factor affecting pain scores at 24 hours postoperatively (P < .05). CONCLUSIONS: IBPBB provided effective immediate postoperative analgesia until 6 hours postoperatively. Especially until postoperative 2 hours, the VAS pain score was less than 1 point in the IBPBB group; however, there was significant rebound pain at 12 hours after surgery. During the first 24 hours postoperatively, PCIA reduced postoperative pain without rebound pain. Surgeons should choose methods for control of postoperative pain considering the advantages and disadvantages of each analgesic method. SN - 1532-6500 UR - https://www.unboundmedicine.com/medline/citation/29605659/Interscalene_brachial_plexus_bolus_block_versus_patient_controlled_interscalene_indwelling_catheter_analgesia_for_the_first_48_hours_after_arthroscopic_rotator_cuff_repair_ DB - PRIME DP - Unbound Medicine ER -