title: Interscalene brachial plexus block with a continuous catheter insertion system and a disposable infusion pump.
abstract: Continuous interscalene brachial plexus blockade traditionally requires a hospital stay for local anesthetic infusion, and achieving consistent catheter insertion may be difficult. Incorporating long-acting pain relief from a continuous peripheral nerve block, with a reliable method of catheter insertion, and a self-contained infusion system would be a valuable asset for short-stay care. We compared the efficacy of single injection interscalene brachial plexus blockade to a continuous peripheral nerve block, with an insulated Tuohy system and a disposable infusion pump. Forty adult patients scheduled for open rotator cuff repair were entered in this randomized, double-blinded, placebo-controlled study. Patients received an interscalene brachial plexus blockade and a continuous peripheral nerve catheter as their primary anesthetic and then, were assigned to receive one of two different postoperative infusions: either 0.2% ropivacaine at 10 mL/h via a disposable infusion pump or normal saline at 10 mL/h via a disposable infusion pump (n = 18-20 per group). Visual analog pain scores and postoperative morphine consumption were measured for 24 h. The ropivacaine group showed less pain than the placebo group (P: = 0.0001) between 12 and 24 h after the initial injection of local anesthetic. In addition, initial interscalene blockade was successful in all patients and all redosed catheters were functional after 24 h with the continuous catheter insertion system. We conclude that it is possible to achieve a high rate of successful catheter placement and analgesia by using the continuous catheter insertion system and a disposable infusion pump in the ambulatory setting. This method of analgesia may offer improved pain relief after outpatient rotator cuff repair.
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA. klein006@mc.duke.edu
authors.forename: S M
authors.initials: SM
authors.lastname: Klein
authors.forename: S A
authors.initials: SA
authors.lastname: Grant
authors.forename: R A
authors.initials: RA
authors.lastname: Greengrass
authors.forename: K C
authors.initials: KC
authors.lastname: Nielsen
authors.forename: K P
authors.initials: KP
authors.lastname: Speer
authors.forename: W
authors.initials: W
authors.lastname: White
authors.forename: D S
authors.initials: DS
authors.lastname: Warner
authors.forename: S M
authors.initials: SM
authors.lastname: Steele
mesh_terms: D000293:Adolescent; D000328:Adult; D000577:Amides / Q000097:blood; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000097:blood; D001917:Brachial Plexus; D002404:Catheterization / Q000295:instrumentation / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009407:Nerve Block / Q000295:instrumentation*; D019637:Orthopedic Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology; D000077212:Ropivacaine; D012782:Shoulder / Q000601:surgery
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine