Intermittent Interscalene Brachial Plexus Block vs. Continuous Intraarticular Infusion for the Management of Postoperative Pain after Shoulder Surgery

Choi, Woo Jong; Choi, Kyu Taek; Lee, Ji Hee; Lee, Yoon Young

Abstract

BACKGROUND: Severe postoperative pain is a well-known problem following shoulder surgery. This study evaluates the clinical efficacy of intermittent interscalene brachial plexus block (ISBPB) compared with that of continuous intraarticular infusion (IAPCA) for the management of postoperative pain after shoulder surgery.
METHODS
Fifty seven patients, scheduled for shoulder surgery during general anesthesia, were randomly allocated to one of two groups. Group ISBPB (n = 19) received a preoperative interscalene brachial plexus block using 20 ml of 0.5% bupivacaine followed by insertion of a 20-gauge polyamide catheter. This catheter was connected to a patient-controlled analgesia pump set immediately after surgery to administer a bolus of 0.75% ropivacaine 15 ml at lockout time intervals 8 hours. Group IAPCA (n = 38) received patient- controlled analgesia with 0.2% ropivacaine 100 ml (basal rate 2 ml/hr, bolus 0.5 ml, lockout time 15 min). Both groups received intravascular patient-controlled analgesia with fentanyl 10? 15 microg/ml (basal rate 1 ml/hr, bolus 2 ml, lockout time 15 min). All patients were given pethidine 25 or 50 mg when visual analogue score (VAS) >40 mm. VAS, circulatory and respiratory stress parameter (heart rate, noninvasive blood pressure and respiratory rate) and consumption of pethidine were measured during 72 hours following surgery at intervals of 8 hours.
RESULTS
The mean VAS scores in the ISBPB group were significantly lower than in the IAPCA group for 72 hr after surgery (P < 0.01). Pethidine consumption in the ISBPB group was significantly lower than in the IAPCA group (P < 0.01).
CONCLUSIONS
We concluded that intermittent interscalene brachial plexus block is an effective method of postoperative analgesia after major shoulder surgery.