title: Buprenorphine, Clonidine, Dexamethasone, and Ropivacaine for Interscalene Nerve Blockade: A Prospective, Randomized, Blinded, Ropivacaine Dose-Response Study.
abstract: This study investigated interscalene block for shoulder arthroplasty with various ropivacaine concentrations in the presence of clonidine, dexamethasone, and buprenorphine. The goal was prolonged analgesia with minimal motor blockade.
  
  
  
  Prospective, double-blind, randomized controlled trial.
  
  
  
  University-affiliated orthopedic hospital.
  
  
  
  Patients (20/group) received acetaminophen, ketorolac, pregabalin, opioids, and "Control"; interscalene block, 0.375% ropivacaine, intravenous additives (buprenorphine, clonidine, dexamethasone); "High Dose"; 0.375% ropivacaine, perineural additives; "Medium Dose"; 0.2% ropivacaine, perineural additives; and "Low Dose"; 0.1% ropivacaine, perineural additives.
  
  
  
  Pain with movement at 24 hours was 4.9 ± 2.5 (mean ± standard deviation [SD]) (Control), 4.5 ± 3.0 (High Dose), 3.4 ± 1.8 (Medium Dose), 4.2 ± 2.4 (Low Dose). The difference between Medium Dose and Control was -1.5 (95% CI: -2.9, -0.1) (P = 0.040). Median time until need for opioids was 16.1 hours (Control) vs 23.7 hours (High Dose); hazard ratio 0.37 [95% CI: 0.17, 0.79]. High Dose had less pain with movement the morning after surgery, vs Control; 2.9 ± 2.5 vs 4.9 ± 2.7; P = 0.027. Pain with movement in the Post-Anesthesia Care Unit was higher in Low Dose, vs Control; 0.9 ± 1.4 vs 0 ± 0, P = 0.009. Low Dose had superior hand strength in the Post-Anesthesia Care Unit (mean ± SD of pre-operative strength: 44.0 ± 20.3%) compared to Control (27.5 ± 24.5%) (P = 0.031).
  
  
  
  For maximum pain reduction, combining perineural additives with ropivacaine 0.375% or 0.2% is suggested. To minimize motor blockade, perineural additives can be combined with ropivacaine, 0.1%.
authors.affiliation: Departments of *Anesthesiology, and Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA; yadeauj@hss.edu.
authors.forename: Jacques T
authors.initials: JT
authors.lastname: YaDeau
authors.affiliation: Departments of *Anesthesiology, and Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA;
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gordon
authors.affiliation: Departments of *Anesthesiology, and Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA;
authors.forename: Enrique A
authors.initials: EA
authors.lastname: Goytizolo
authors.affiliation: Departments of *Anesthesiology, and Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA;
authors.forename: Yi
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Departments of *Anesthesiology, and Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA; Healthcare Research Institute, Hospital for Special Surgery, New York, New York, USA;
authors.forename: Kara G
authors.initials: KG
authors.lastname: Fields
authors.affiliation: Departments of *Anesthesiology, and Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA;
authors.forename: Amanda K
authors.initials: AK
authors.lastname: Goon
authors.affiliation: Departments of *Anesthesiology, and Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA;
authors.forename: Guilherme
authors.initials: G
authors.lastname: Holck
authors.affiliation: Departments of *Anesthesiology, and Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA;
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Miu
authors.affiliation: Departments of *Anesthesiology, and Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA;
authors.forename: Lawrence V
authors.initials: LV
authors.lastname: Gulotta
authors.affiliation: Departments of *Anesthesiology, and Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA;
authors.forename: David M
authors.initials: DM
authors.lastname: Dines
authors.affiliation: Departments of *Anesthesiology, and Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA; Healthcare Research Institute, Hospital for Special Surgery, New York, New York, USA;
authors.forename: Edward V
authors.initials: EV
authors.lastname: Craig
mesh_terms: D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002047:Buprenorphine / Q000008:administration & dosage*; D003000:Clonidine / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control; D011446:Prospective Studies; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D002047:Buprenorphine; D000077212:Ropivacaine; D003907:Dexamethasone; D003000:Clonidine
keywords: Buprenorphine; Clonidine; Dexamethasone; Interscalene Nerve Block; Ropivacaine; Total Shoulder Arthroplasty
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