Continouous versus Single-injection Interscalene block for minor Shoulder surgery
Continuous versus Single Shot regional block in shoulder surgery
wellington hospital orthopaedic department
50 participants
Mar 1, 2016
Interventional
Conditions
Summary
Minor shoulder surgery is a commonly performed surgical procedure in New Zealand. This includes various forms of mini-open and arthroscopic procedures such as acromial spur removal, rotator cuff repair, excision of distal clavicle, and shoulder stabilisation. Patients undergoing these procedures frequently report pain in the immediate post operative recovery period. Without proper pain management, complications can occur such as excessive analgesia usage, complex regional pain and delayed rehabilitation. These problems consequently lead to patient’s dissatisfaction and disability, unnecessary hospital admissions, and sometimes further surgery. The addition of a regional interscalene block to the standard general anaesthesia helps to significantly reduce pain in the first week after rotator cuff surgery. There are two alternative methods of delivery of the regional block. A single shot injection block was performed by the anaesthetist by placing local anaesthetic agent around the interscalene region prior to surgery. Alternatively a continuous block utilises a pump delivering five days of the same local anaesthetic agent to the same region. Both blocks are commonly practiced in New Zealand, however the effectiveness has not been clearly distinguished in all minor shoulder surgery procedures. This study aim to investigate the difference between these two blocks in terms of patient’s pain management during the first week after surgery.
Eligibility
Inclusion Criteria1
- All patients undergoing minor shoulder surgery in wellington catchment area
Exclusion Criteria5
- Unwilling to consent – those unwilling to consent to participation in the study cannot be included due to ethical reasons.
- Major shoulder surgery – those who are undergoing major shoulder surgery with surgical incision of more than five centimetres were excluded such as arthroplasty surgery or open shoulder stabilisation procedures. These were generally more painful with prolonged recovery.
- Complex regional pain syndrome – those who have existing complex regional pain syndrome or previous hyper sensitivity to pain were likely to have significant difficulties with pain management after surgery.
- Contraindications to interscalene regional block – those who have absolute contraindications to regional block are excluded, such as severe allergic reaction to local anaesthetic agent or contralateral phrenic nerve dysfunction.
- Failed regional block – those who have severe pain immediately after surgery with clinical evidence of normal sensation of the intended block region were excluded. Normal sensation indicates the regional block may not been placed around the targeted nerve.
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Interventions
To compare two different forms of delivery of regional anaesthesia during shoulder surgery The continuous block uses 20ml of 0.5% ropivacaine as a bolus through a catheter prior to general anaesthesia, after a surgical duration of average 90 minutes, the block is administered post operatively with continuous infusion of 0.2% ropivacaine at 2 ml/h with patient-controlled bolus of 5 ml hourly for five days post surgery. The patient press a button on the pump to administer 5ml of ropivacaine when they experience pain, this is in addition to the base rate of 2ml/hr. The patient can not have another 5ml additional bolus until an hour later for safety reason. This is common administration for all currently available regional block pain pump. The anaesthetist places the block using ultrasound guidance aiming at the region around brachial plexus between the neck and the clavicle. The success of the block is checked with a cold object (e.g ice cube) after patient is awake after surgery.
Locations(1)
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ACTRN12616000095460