title: Continuous interscalene brachial plexus blockade provides good analgesia at home after major shoulder surgery-report of four cases.
abstract: OBJECTIVE
  Continuous interscalene brachial plexus blockade (CIBPB) in a hospital setting can provide excellent surgical conditions and postoperative analgesia for major shoulder surgery. This is a case report of four patients on the efficacy and advantages of CIBPB for postoperative analgesia at home.
  
  
  METHODS
  Four patients scheduled for rotator cuff repair under CIBPB were discharged home the day of surgery with an interscalene catheter connected to an automated infusion pump administering 0.2% ropivacaine at 10 mL x hr(-1) for 72 hr. Prior to discharge, patients and their attendant were given verbal and written instructions concerning local anesthetic toxicity and explicit contact information for an anesthesiologist or nurse. Outcomes were measured pre- and postoperatively, including verbal analogue pain scores (pain VAS), verbal analogue nausea scores (nausea VAS), side effects, cognitive function (mini-mental state questionnaire), sleep (hours/night), and patient satisfaction (Likert scale). Postoperative VAS scores over three days were very low. Two patients reported only one episode of nausea. There were no complications associated with local anesthetic toxicity or catheter use. Cognitive function improved over three days. Sleep increased from a mean of five hours before surgery to seven hours over the next three nights. Patient satisfaction with care was high. Significant cost savings were documented.
  
  
  CONCLUSIONS
  The use of CIBPB for 72 hr in patients undergoing major ambulatory shoulder surgery can result in good analgesia with minimal opioid requirement, cost savings and possibly improvement in outcome measures.
authors.affiliation: Department of Anesthesiology, University Medical Center, Durham, North Carolina 27710, USA. niels006@mc.duke.edu
authors.forename: Karen C
authors.initials: KC
authors.lastname: Nielsen
authors.forename: Roy A
authors.initials: RA
authors.lastname: Greengrass
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pietrobon
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Klein
authors.forename: Susan M
authors.initials: SM
authors.lastname: Steele
mesh_terms: D000368:Aged; D000556:Ambulatory Surgical Procedures; D016058:Analgesia, Patient-Controlled / Q000295:instrumentation*; D001917:Brachial Plexus; D002404:Catheterization / Q000295:instrumentation; D018575:Home Care Services, Hospital-Based; D006801:Humans; D007260:Infusion Pumps; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects* / Q000295:instrumentation*; D017006:Rotator Cuff / Q000601:surgery*; D013997:Time Factors