Postoperative Analgesia in a Prolonged Continuous Interscalene Block Versus Single-Shot Block in Outpatient Arthroscopic Rotator Cuff Repair: A Prospective Randomized Study.
To compare the analgesic efficacy of 3-day continuous interscalene brachial plexus block versus a single-shot block for arthroscopic rotator cuff repair.



Eighty-five patients scheduled for arthroscopic rotator cuff repair were randomly assigned to either the single-shot group (SSG) or continuous interscalene brachial block group (CG). Patients in the SSG received 2.5 mg/kg of 0.5% bupivacaine up to 25 mL; the CG received the same dose as a loading dose via catheter followed by an infusion of 0.125% bupivacaine at 5 mL/h and a patient-controlled bolus of 5 mL hourly for 72 hours. Follow-up after discharge was with telephone calls over the next 3 days. Pain was measured on a visual analog scale. Also measured were sleep disturbance, number of opioid doses taken, adverse effects, and level of patient satisfaction.



The median rest pain scores on the 3 days of follow-up measured on a scale of 0 to 10 (with 10 equal to greatest pain) were 0, 0, and 3 in the CG compared with 4, 4, and 3 in the SSG (P < .001) for days 1, 2, and 3, respectively. The median maximum scores were 2, 2, and 4 in the CG compared with 8, 7, and 6 in the SSG (P < .001) for the same time period.



A 3-day continuous interscalene brachial plexus block provides better analgesia than a single-shot block. Sleep patterns were better, and less opioid was needed after arthroscopic rotator cuff repair in patients given a continuous plexus block.



Level I, prospective randomized study.
Department of Anesthesia and Critical Care, The University of Hospitals, Chicago, Illinois, U.S.A.. Electronic address: tmalik@dacc.uchicago.edu.
Tariq
T
Malik
Department of Orthopedics and Rehabilitation Medicine, The University of Hospitals, Chicago, Illinois, U.S.A.
Daniel
D
Mass
Department of Anesthesia and Critical Care, The University of Hospitals, Chicago, Illinois, U.S.A.
Stephan
S
Cohn
D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001182:Arthroscopy / Q000379:methods*; D065527:Brachial Plexus Block / Q000379:methods*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D000070636:Rotator Cuff Injuries / Q000601:surgery*
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D002045:Bupivacaine