Interscalene brachial plexus block for open-shoulder surgery: a randomized, double-blind, placebo-controlled trial between single-shot anesthesia and patient-controlled catheter system.
BACKGROUND
Interscalene brachial plexus block (ISB) is widely used as an adjuvant regional pain therapy in patients undergoing major shoulder surgery and has proved its effectiveness on postoperative pain reduction and opioid-sparing effect.


METHODS
This single-center, prospective, double-blind, randomized and placebo-controlled study was to compare the effectiveness of a single-shot and a patient-controlled catheter insertion ISB system after major open-shoulder surgeries. Seventy patients were entered to receive an ISB and a patient-controlled interscalene catheter. The catheter was inserted under ultrasound guidance. Patients were then assigned to receive one of two different postoperative infusions, either 0.2% ropivacaine (catheter group) or normal saline solution (single-shot group) via a disposable patient-controlled infusion pump.


RESULTS
The study variables were amount of rescue medication, pain at rest and during physiotherapy, patient satisfaction and incidence of unwanted side effects. The ropivacaine group revealed significantly less consumption of rescue medication within the first 24 h after surgery. Incidence of side effects did not differ between the two groups.


CONCLUSIONS
Based on our results, we recommend the use of interscalene plexus block in combination with a patient-controlled catheter system under ultrasound guidance only for the first 24 h after major open-shoulder surgery.
Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Wuerzburg, Germany. s-goebel.klh@mail.uni-wuerzburg.de
Sascha
S
Goebel
Jens
J
Stehle
Ulrich
U
Schwemmer
Stephan
S
Reppenhagen
Beatrice
B
Rath
Frank
F
Gohlke
D000328:Adult; D000368:Aged; D000577:Amides; D016058:Analgesia, Patient-Controlled; D000779:Anesthetics, Local; D001917:Brachial Plexus; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D011446:Prospective Studies; D000077212:Ropivacaine; D012782:Shoulder / Q000601:surgery*
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine