title: Analgesic efficacy of two interscalene blocks and one cervical epidural block in arthroscopic rotator cuff repair.
abstract: OBJECTIVE
  Despite its effectiveness in other surgeries, studies on continuous epidural block in upper-extremity surgery are rare because of technical difficulties and potential complications. This study compared postoperative analgesic efficacy and safety of ultrasound-guided continuous interscalene brachial plexus block (UCISB) and fluoroscopy-guided targeted continuous cervical epidural block (FCCEB) in arthroscopic rotator cuff repair (ARCR).
  
  
  METHODS
  Seventy-five patients were randomly and equally assigned to groups FCCEB (0.2%), UCISB75 (0.75%), and UCISB20 (0.2%) according to the initial ropivacaine dose (8 ml). The background infusion (0.2% ropivacaine at 5 ml/h), bolus (3 ml of 0.2% ropivacaine), and lockout time (20 min) were consistent. Respiratory effects [respiratory discomfort (modified Borg scale), ventilatory function, and hemidiaphragmatic excursion (ultrasound)], analgesic quality [pain severity at rest and motion attempt (VAS-R and -M), number of boluses, analgesic supplements, and sleep disturbance], neurologic effects, procedural discomfort, satisfaction, and adverse effects were evaluated preprocedurally and up to 72 h postoperatively.
  
  
  RESULTS
  FCCEB caused less respiratory depression and sensorimotor block, but had less analgesic efficacy than UCISBs (P < 0.05). FCCEB caused nausea, vomiting, and dizziness more frequently (P < 0.05) and had lower patient satisfaction than UCISBs (P < 0.05). UCISB75 can cause severe respiratory distress in patients with lung disorders. Other variables were not significantly different between the groups.
  
  
  CONCLUSIONS
  UCISB20 may provide superior postoperative analgesia and is the most recommendable postoperative analgesic method in ARCR.
  
  
  METHODS
  Randomized controlled trials, Therapeutic study, Level I.
authors.affiliation: Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 224-1 Heukseok-dong, Dongjak-gu, Seoul, Republic of Korea.
authors.forename: Jae-Yoon
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 224-1 Heukseok-dong, Dongjak-gu, Seoul, Republic of Korea.
authors.forename: Kwang-Sup
authors.initials: KS
authors.lastname: Song
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 224-1 Heukseok-dong, Dongjak-gu, Seoul, Republic of Korea.
authors.forename: Won-Joong
authors.initials: WJ
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 224-1 Heukseok-dong, Dongjak-gu, Seoul, Republic of Korea.
authors.forename: Yong-Hee
authors.initials: YH
authors.lastname: Park
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 224-1 Heukseok-dong, Dongjak-gu, Seoul, Republic of Korea.
authors.forename: Hyun
authors.initials: H
authors.lastname: Kang
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 224-1 Heukseok-dong, Dongjak-gu, Seoul, Republic of Korea.
authors.forename: Young-Cheol
authors.initials: YC
authors.lastname: Woo
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 224-1 Heukseok-dong, Dongjak-gu, Seoul, Republic of Korea. pain@cau.ac.kr.
authors.forename: Hwa-Yong
authors.initials: HY
authors.lastname: Shin
mesh_terms: D000577:Amides / Q000008:administration & dosage*; D015360:Analgesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001182:Arthroscopy; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control; D000077212:Ropivacaine; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D018084:Ultrasonography, Interventional
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
keywords: Analgesia; Arthroscopes; Brachial plexus; Epidural; Rotator cuff