title: Interscalene brachial plexus block with continuous intraarticular infusion of ropivacaine.
abstract: Providing intraarticular analgesia with a continuous infusion of local anesthetic via a disposable infusion pump has gained popularity. Despite the prevalence of this technique, data comparing this method of analgesia to conventional regional anesthesia are not available. We present a prospective study that compared a single-dose interscalene block with a single-dose interscalene block plus continuous intraarticular infusion of local anesthetic. Forty patients scheduled for shoulder arthroscopy were entered in this prospective, double-blinded study. All patients received an interscalene brachial plexus block as their primary anesthetic. Patients were randomly assigned to 1 of 2 groups: 1. interscalene block with 1.5% mepivacaine (40 mL) followed by a postoperative intraarticular infusion of 0.5% ropivacaine at 2 mL/h, or 2. interscalene block with 0.5% ropivacaine (40 mL) followed by a postoperative intraarticular infusion of 0.9% saline (placebo) at 2 mL/h. Postoperative infusions were maintained for 48 h. Visual analog scale pain scores and postoperative oxycodone consumption were measured for 48 h. Visual analog scale scores at rest and with ambulation in the Mepivacaine/Intraarticular Ropivacaine group were reduced when compared with the Ropivacaine/Saline group (rest: P = 0.003, ambulation: P = 0.006). Oxycodone consumption was also decreased (28 +/- 21 mg vs 44 +/- 28 mg, P = 0.046), respectively. We conclude that a brachial plexus block with 1.5% mepivacaine and a continuous intraarticular infusion of 0.5% ropivacaine at 2 mL/h provides improved analgesia for minor surgery at 24 and 48 h versus a single-injection interscalene block with 0.5% ropivacaine.
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: K C
authors.initials: KC
authors.lastname: Nielsen
authors.forename: A
authors.initials: A
authors.lastname: Martin
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
authors.forename: K P
authors.initials: KP
authors.lastname: Speer
authors.forename: R A
authors.initials: RA
authors.lastname: Greengrass
mesh_terms: D000328:Adult; D000577:Amides; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local; D001917:Brachial Plexus; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D007270:Injections, Intra-Articular; D008297:Male; D008619:Mepivacaine / Q000627:therapeutic use; D009407:Nerve Block; D010098:Oxycodone / Q000627:therapeutic use; D010147:Pain Measurement; D011446:Prospective Studies; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D008619:Mepivacaine; D010098:Oxycodone