Does interscalene catheter placement with stimulating catheters improve postoperative pain or functional outcome after shoulder surgery? A prospective, randomized and double-blinded trial.
BACKGROUND
In this prospective, randomized, double-blind trial we investigated the use of stimulating catheters in patients during and after shoulder surgery; functional improvement being the primary outcome measurement.


METHODS
After eliciting an adequate muscular twitch at < or =0.5 mA nerve stimulation output, the perineural catheter was advanced either blindly (conventional catheter = CC group, n = 20) or guided by stimulation via the catheter (stimulating catheter = SC group, n = 20). A bolus of 40 mL prilocaine 1% and 10 mL ropivacaine 0.75% was injected, followed by a patient-controlled infusion of ropivacaine 0.2% (8 mL/h infusion rate, bolus 2 mL, lockout time 20 min).


RESULTS
Onset of motor block was faster in the SC group, whereas sensory block did not differ between groups. Median pain scores on two postoperative days were equal. Improvement of the objective shoulder function score (Constant Murley Score) 6 wk postoperatively was enhanced to a clinically relevant extent in the SC group compared to the CC group (P < 0.01).


CONCLUSIONS
We conclude that the use of a stimulating catheter results in a faster onset of motor block, unaltered postoperative pain, and a significantly improved functional outcome 6 wk after shoulder surgery.
Stevens
Markus F
MF
Department of Anesthesiology, University of Düsseldorf, Düsseldorf, Germany. markus.stevens@med.uni-duesseldorf.de
Werdehausen
Robert
R
Golla
Elisabeth
E
Braun
Sebastian
S
Hermanns
Henning
H
Ilg
Ansgar
A
Willers
Reinhardt
R
Lipfert
Peter
P
D000328:Adult; D000765:Anesthesia, Conduction / Q000295:instrumentation / Q000379:methods*; D001917:Brachial Plexus / Q000502:physiology / Q000601:surgery; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D004311:Double-Blind Method; D004558:Electric Stimulation / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000295:instrumentation / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D012782:Shoulder / Q000502:physiology / Q000601:surgery*; D016896:Treatment Outcome