Prospective study of ultrasound-guided peri-plexus interscalene block with continuous infusion catheter for arthroscopic rotator cuff repair and postoperative pain control

Abstract

ObjectiveThis trial investigated postoperative analgesia in arthroscopic rotator cuff repair surgery patients under general anesthesia, associated with ultrasound-guided peri-plexus interscalene brachial plexus block (US-IBPB), and compared single injection to elastomeric pump continuous infusion of local anesthetics. Complications associated to both techniques are described. MethodsIn this prospective, quasi-randomized controlled clinical trial, 68 adults scheduled for elective arthroscopic rotator cuff repair were assigned to receive Group 1 (G1=41) US-IBPB with a 20mL injection of 0.5% peri-plexus ropivacaine, introduction of catheter, injection of 20mL of 0.5% ropivacaine through continuous catheter infusion of local anesthetic by elastomeric pump (ropivacaine 0.2%, infusion of 5mL/h). In Group 2 (G2=27), US-IBPB, with a single peri-plexus injection of 40mL ropivacaine 0.5%. In both groups oral analgesics were prescribed, paracetamol 500mg associated to codeine 30mg for patients with VAS between 3 and 5, and also oxycodone 20mg for VAS≥6. The anesthesiology team was available through contact telephones and the patients received a table to complete in order to report pain intensity according to VAS, use of oral medication, and complications related to the catheter and pump, until the third postoperative day. ResultsThe intensity of pain was higher on second day after surgery than on days 1 and 3, in both groups confirmed by the ANOVA test (p=0.00006) Among the groups, G1 patients had lower pain intensity than G2, (p=0.000197). G2 patients presented greater pain intensity during all periods studied (days 1, 2, and 3) than G1 patients. Postoperatively, G2 patients had higher consumption of rescue analgesics, nausea, and vomiting (40.74%) vs. G1 (5%) and dizziness (25.92%). No patient with catheter and elastomeric pump (G1) had complications regarding its insertion and maintenance during postoperative period. ConclusionThe quality of analgesia for arthroscopic rotator cuff repair with peri-plexus US-IBPB and continuous infusion with elastomeric pump presented superior postoperative analgesia quality to single puncture IBPB on postoperative days 2 and 3, with lower consumption of rescue opioids in this period.