Continuous Interscalene Block Results in Superior Recovery Throughout the First Postoperative Week
Condition: Postoperative Pain; Adverse Effects
MeSH terms: Pain, Postoperative
Study type: Interventional
Phase: Early Phase 1

Summary: 
      The investigators undertook this prospective, randomized trial to compare the recovery
      profile throughout the first postoperative week in patients receiving continuous (CISB)
      interscalene brachial plexus block, single injection (SISB), or general anesthesia (GA) for
      arthroscopic rotator cuff repair surgery. Specifically, the effects of the three anesthetic
      techniques when used intraoperatively as a sole anesthesia modality were studied on
      postoperative pain, time-to-first pain, analgesic consumption, fast-tracked PACU bypass rate,
      length of PACU stay, time-to-discharge home, sleep duration, and related adverse effects. The
      investigators hypothesized that CISB results in a superior postoperative recovery profile as
      compared to SISB or GA alone.
    

Detailed description: 
      Background The advantages of single injection (SISB) and continuous interscalene brachial
      plexus block (CISB) over general anesthesia (GA) only have been previously reported. However,
      few studies extended their observations beyond 48 postoperative hours, and no study has
      compared the effects of SISB and CISB as sole anesthesia modalities with GA only. We
      undertook this randomized trial to compare the recovery profile of patients receiving SISB,
      CISB or GA for arthroscopic rotator cuff repair surgery through the first postoperative week.
      Our primary hypothesis was that highest NRS pain rating (worst pain score) at the end of the
      study week is lower for patients in the CISB group than for patients in the SISB or GA
      groups.

      Methods After Institutional Review Board approval and informed consents were obtained, 71
      patients of American Society of Anesthesiologists (ASA) physical status I-III, ≥18 years of
      age, and BMI≤35 kg/m2, scheduled for elective outpatient arthroscopic rotator cuff repair,
      were enrolled. CISB patients received 20 mL of 0.5% ropivacaine as bolus through the catheter
      whereas SISB patients received the same volume of injection through a needle. CISB patients
      received an infusion of 0.2% ropivacaine at 5mL/h with a patient controlled bolus of 5 mL
      hourly. GA only patients received a standardized general anesthetic. All patients were
      prescribed acetaminophen (500mg) with hydrocodone (7.5mg) every 4h as needed. CISB was
      discontinued 48 h after surgery. Postoperative highest pain scores (NRS) through the first
      postoperative week, time-to-first pain, analgesic consumption, fast-tracked postoperative
      care unit (PACU) bypass rate, length of PACU stay, time-to-discharge home, sleep duration,
      and related adverse effects were recorded in the PACU and at home on postoperative days 1, 2,
      3, and 7.
    

Intervention name(s): ISB
Intervention type(s): Procedure
Intervention description(s): In SISB group; a 5 cm block needle (Stimuplex®A, B Braun Medical, Bethlehem, PA) was inserted in-plane in order to place the needle tip between the upper and middle trunks of the brachial plexus (C5-C6). 20 mL 0.5% ropivacaine was injected through the needle.
For CISB, a 5cm stimulating needle (Contiplex® Tuohy, B. Braun Medical, Bethlehem, PA) was inserted in-plane in order to place the needle tip between the upper and middle trunks of the brachial plexus (C5-C6). A nonstimulating catheter was inserted approximately 3 cm beyond the tip of the needle. 20 mL 0.5% ropivacaine was injected through the catheter.
Other intervention name(s): SISB needle (Stimuplex®A, B Braun); CISB needle and catheter (Contiplex® Tuohy, B. Braun)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Supportive Care
Keywords: Single injection interscalene brachial plexus block; Continuous interscalene brachial plexus block; General anesthesia; Postoperative pain; Recovery profile