A clinical comparison of continuous interscalene brachial plexus block with different basal infusion rates of 0.2% ropivacaine for shoulder surgery

Abstract

BackgroundA continuous interscalene brachial plexus block is a highly effective postoperative analgesic modality after shoulder surgery. However, there is no consensus regarding the optimal basal infusion rate of ropivacaine for a continuous interscalene brachial plexus block. A prospective, double blind study was performed to compare two different basal rates of 0.2% ropivacaine for a continuous interscalene brachial plexus block after shoulder surgery.MethodsSixty-two patients receiving shoulder surgery under an interscalene brachial plexus block were included. The continuous interscalene brachial plexus block was performed using a modified lateral technique with 30 ml of 0.5% ropivacaine. Surgery was carried out under an interscalene brachial plexus block or general anesthesia. After surgery, the patients were divided randomly into two groups containing 32 each. During the first 48 h after surgery, groups R8 and R6 received a continuous infusion of 0.2% ropivacaine at 8 ml/h and 6 ml/h, respectively. The pain scores at rest and on movement, supplemental analgesia, motor block, adverse events and patient's satisfaction were recorded.ResultsThe pain scores, supplemental analgesia, motor block, adverse events and patient's satisfaction were similar in the two groups.ConclusionsWhen providing continuous interscalene brachial plexus block after shoulder surgery, 0.2% ropivacaine at a basal rate of 8 ml/h or 6 ml/h produces similar clinical efficacy. Therefore, decreasing the basal rate of CISB is more appropriate considering the toxicity of local anesthetics.

Infusion Methods for Continuous Interscalene Brachial Plexus Block for Postoperative Pain Control after Arthroscopic Rotator Cuff Repair

“…In a previous study of open shoulder surgery, continuous ISBP analgesia required a basal infusion to provide effective pain relief, with a basal infusion of 5 ml/h [ 20 21 ]. Reducing the basal infusion from 8 to 6 ml/h resulted in similar clinical efficacy in shoulder surgery with ISBPB [ 7 ]. A basal infusion of 2 ml/h resulted in postoperative pain, night awakening, and tramadol consumption after rotator cuff surgery similar to that of an infusion of 5 ml/h, and the smaller infusion decreased the frequency of side effects [ 22 ].…”

“…Pain quality by NRS was the primary outcome variable on which sample size estimation was based. A previous study found that the NRS score on postoperative day 1 was 1.9 ± 2.0 (mean ± SD) [ 7 ]. We assumed a 20% difference in the average pain scores over a 48-hour period between the groups to be the minimum relevant difference.…”

Low-dose ropivacaine for supraclavicular brachial plexus block combined with general anesthesia for successful postoperative analgesia: A case series

“…[5] have shown that one shot of 30 mL 0.5% ropivacaine with a continuous infusion of 0.2% ropivacaine at 6 mL/h or 8 mL/h for BPB without general anesthesia provided similar clinical efficacy. On the basis of this result, they concluded that the basal rate should be decreased in light of the toxicity of local anesthetics.…”

“…In addition, the use of the conventional dose of ropivacaine would have increased the occurrence of adverse events, such as prolonged numbness and delayed sensory and motor recovery, even though a higher dose of ropivacaine or bupivacaine (0.5% at 30 mL) has not been reported to induce any critical events when used for BPB. [56]…”

A Randomized Comparison of Ropivacaine 0.1% and 0.2% for Continuous Interscalene Block After Shoulder Surgery

“…Using a nerve stimulator (Stimuplex HNS12, B. Braun, Melsungen, Germany) initially set at 1.0 mA, 0.1 milliseconds, and 1 Hz, an end-hole catheter (Contiplex A, B. Braun) was inserted with a technique similar to one previously described using a sustained contraction end point of the deltoid, pectoralis, biceps, or triceps muscles at 0.6 mA. 4 Ropivacaine 0.5% 30 mL was injected through the catheter. The catheter was subcutaneously tunneled over 3 to 4 cm through an 18-gauge IV needle and was fixed to the skin with a suture.…”