Abstract | BACKGROUND: This prospective, randomized study tested the hypothesis that a reduced dose continuous interscalene regimen incorporating a low background infusion with mandatory boluses would provide similar shoulder surgery analgesia compared with a dose regimen incorporating a conventional higher background infusion. METHODS: After rotator cuff surgery, patients received via an interscalene catheter, one of two elastomeric pumps, each having a 5 ml per 60 min bolus function and a 2 ml h⁻¹ (n=38) or 5 ml h⁻¹ (n=43) ropivacaine 2 mg ml⁻¹ infusion. Boluses commenced from the onset of pain and continued for >48 h as required (pro re nata, PRN) up to every hour for a numerical rating pain score (NRPS, 0-10) >2. Group 2 ml h⁻¹ received mandatory 6 hourly boluses irrespective of the NRPS. Rescue tramadol was available. Patients were questioned on postoperative days 1 and 2 for treatment effectiveness and side-effects. RESULTS:
Postoperative pain was similar between the groups [Group 2 ml h⁻¹ day 2 median (IQR) (95% confidence interval of the mean) worst movement pain=4 (1-5) (2.8-4.7) vs 4 (2-5) (3.1-4.6), P=0.99], as were night awakenings and tramadol consumption. Numerically rated numbness and weakness were similar between the groups; however, nine patients (21%) in the 5 ml h⁻¹ group vs one (3%) in the 2 ml h⁻¹ group required a temporary infusion cessation due to side-effects (predominantly hand numbness) (P=0.02). CONCLUSIONS: Continuous interscalene ropivacaine 0.2% 2 ml h⁻¹ with mandatory 6 hourly (and PRN) boluses provides similar analgesia after rotator cuff repair but with reduced side-effects compared with 5 ml h⁻¹ with PRN only boluses.
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Authors | M J Fredrickson, A Abeysekera, D J Price, A C Wong |
Journal | British journal of anaesthesia
(Br J Anaesth)
Vol. 106
Issue 2
Pg. 239-45
(Feb 2011)
ISSN: 1471-6771 [Electronic] England |
PMID | 21112881
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Amides
- Anesthetics, Local
- Ropivacaine
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Topics |
- Adult
- Aged
- Ambulatory Care
(methods)
- Amides
(administration & dosage)
- Analgesia, Patient-Controlled
(adverse effects, methods)
- Anesthetics, Local
(administration & dosage)
- Arthroscopy
- Brachial Plexus
- Drug Administration Schedule
- Female
- Humans
- Male
- Middle Aged
- Nerve Block
(adverse effects, methods)
- Pain Measurement
(methods)
- Pain, Postoperative
(prevention & control)
- Postoperative Care
(methods)
- Prospective Studies
- Ropivacaine
- Rotator Cuff
(surgery)
- Rotator Cuff Injuries
- Shoulder Joint
(surgery)
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