title: Continuous interscalene block in patients having outpatient rotator cuff repair surgery: a prospective randomized trial.
abstract: BACKGROUND
  We performed this randomized trial to compare the recovery profile of patients receiving single injection (SISB) and continuous interscalene brachial plexus block (CISB) or general anesthesia (GA) for arthroscopic rotator cuff repair surgery through the first postoperative week. Our primary hypothesis was that the highest pain numeric rating scale (NRS) (worst pain score) at the end of the study week would be lower for patients in the CISB group than for patients in the SISB or GA groups.
  
  
  METHODS
  Seventy-one patients scheduled for elective outpatient arthroscopic rotator cuff repair were enrolled. CISB patients received 20 mL of 0.5% ropivacaine as a bolus through a catheter, whereas SISB patients received the same injection volume through a needle. CISB patients received an infusion of 0.2% ropivacaine at 5 mL/h with a patient-controlled bolus of 5 mL hourly for 48 hours. GA-only patients received a standardized general anesthetic. Postoperative highest NRS pain scores through the first postoperative week, time-to-first pain, analgesic consumption, fast-tracked postoperative anesthesia care unit (PACU) bypass rate, length of PACU stay, time-to-discharge home, total hours of sleep, and related adverse effects were recorded in the PACU and at home on postoperative days 1, 2, 3, and 7.
  
  
  RESULTS
  No patient in the CISB or SISB groups reported a NRS ≥1 or required analgesics while in the PACU. While most patients in the CISB and SISB groups were fast-tracked to PACU discharge, no patient in the GA group was fast-tracked (Χ P = 0.003). Length of stay in the PACU was significantly shorter for the CISB and SISB groups than for the GA group (20 ± 31, 30 ± 42, and 165 ± 118 minutes, respectively (CISB vs GA, P < 0.001; SISB vs GA, P <0.001), and time-to-discharge home was significantly shorter when compared with the GA group. Time to first pain report was longer in the CISB group. Mean NRS scores were lower for patients in the CISB group than in the SISB and GA groups on postoperative days 1 and 2, and use of narcotics (doses ≥1) was lower until postoperative day 3. Patients who received CISB slept significantly longer than patients who received SISB or GA (P < 0.01) during the first 48 hours postoperatively. By the end of the study week, 26% of patients in the CISB group, 83% in the SISB group, and 58% of GA patients reported NRS ≥4 (both P-values ≤ 0.05).
  
  
  CONCLUSIONS
  The analgesic benefits of CISB found in the PACU and immediately after discharge extend through the intermediate recovery period ending on postoperative day 7.
authors.affiliation: From the Departments of *Anesthesiology and †Orthopedics, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Emine Aysu
authors.initials: EA
authors.lastname: Salviz
authors.forename: Daquan
authors.initials: D
authors.lastname: Xu
authors.forename: Ashton
authors.initials: A
authors.lastname: Frulla
authors.forename: Kwesi
authors.initials: K
authors.lastname: Kwofie
authors.forename: Uma
authors.initials: U
authors.lastname: Shastri
authors.forename: Junping
authors.initials: J
authors.lastname: Chen
authors.forename: Ali Nima
authors.initials: AN
authors.lastname: Shariat
authors.forename: Sanford
authors.initials: S
authors.lastname: Littwin
authors.forename: Emily
authors.initials: E
authors.lastname: Lin
authors.forename: Jason
authors.initials: J
authors.lastname: Choi
authors.forename: Paul
authors.initials: P
authors.lastname: Hobeika
authors.forename: Admir
authors.initials: A
authors.lastname: Hadzic
mesh_terms: D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects; D000577:Amides / Q000008:administration & dosage* / Q000009:adverse effects; D000700:Analgesics / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D001182:Arthroscopy / Q000009:adverse effects; D001917:Brachial Plexus; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D009519:New York City; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010351:Patient Discharge; D011446:Prospective Studies; D011997:Recovery Room; D020127:Recovery of Function; D000077212:Ropivacaine; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000700:Analgesics; D000779:Anesthetics, Local; D000077212:Ropivacaine