Korean J Pain.  2014 Apr;27(2):125-132. 10.3344/kjp.2014.27.2.125.

Feasibility of Early and Repeated Low-dose Interscalene Brachial Plexus Block for Residual Pain in Acute Cervical Radiculopathy Treated with NSAIDS

• Iwata T
• Mitoro M
• Kuzumoto N

• KMID: 2074058
• DOI: http://doi.org/10.3344/kjp.2014.27.2.125

Abstract

BACKGROUND
To improve residual pain management in acute cervical radiculopathy treated with NSAIDs, the feasibility of early and repeated low-dose interscalene brachial plexus block (IS-BPB) needs to be assessed.
METHODS
This was a prospective study on patients receiving NSAIDs (loxoprofen) for cervical radiculopathy of < or = 2-week onset. Pain was assessed using the visual analogue scale (VAS). A low-dose ultrasonography (USG)-guided IS-BPB (dexamethasone [1.65 mg; 0.5 ml] and mepivacaine [1%; 3.0 ml]) was performed at baseline and weekly thereafter for 4 weeks in an outpatient setting for the intervention group. All patients were evaluated using a visual satisfaction score (VSS) at week 4. Patients with baseline VAS scores < 70 (mild to moderate pain; MM group) and > or = 70 (severe pain; SE group) were compared to the controls receiving NSAIDs.
RESULTS
A total of 316 IS-BPBs were performed in the intervention group. There was a significant difference in the decline in the VAS from week 0 to week 3 in the MM and SE groups (P < 0.05); however, from week 3 to week 4, the therapeutic effect exhibited no significant difference. Thirteen patients at week 2 (15.5%; MM: 27.7%; SE: 0%), 43 at week 3 (51.2%; MM: 83.0%; SE: 10.8%), and 47 at week 4 (56.0%; MM: 85.1%; SE: 18.9%) achieved a VAS score of < or = 20. Patient satisfaction was high, and the decrease in VAS scores in both groups was significant (P < 0.05) compared to the controls.
CONCLUSIONS
Weekly, low-dose, USG-guided IS-BPB can be implemented for early pain relief in acute cervical radiculopathy, with high patient satisfaction.

Keyword

acute; brachial plexus; cervical radiculopathy; low-dose; nerve block

MeSH Terms

Anti-Inflammatory Agents, Non-Steroidal*
Brachial Plexus*
Humans
Mepivacaine
Nerve Block
Outpatients
Pain Management
Patient Satisfaction
Prospective Studies
Radiculopathy*
Ultrasonography
Anti-Inflammatory Agents, Non-Steroidal
Mepivacaine

Figure

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  Fig. 1 Contrast imaging using 3.5 ml of contrast injected via the ultrasonography-guided interscalene brachial plexus block procedure in a volunteer. The image shows that the contrast has spread favourably close to the nerve root.

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  Fig. 2 Change in visual analogue scale scores over the study duration. (♦) Intervention group patients and (▪) Control group. SD: standard deviation, VAS: visual analogue scale.*P < 0.05, compared with control group.

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  Fig. 3 Change in visual analogue scale scores in the (▴) Mild to moderate pain, intervention group, (•) Severe pain, intervention group, and (▪) Control group, over the study duration. SD: standard deviation, VAS: visual analogue scale.*P < 0.05, compared with control group.

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