TY - JOUR
T1 - Analgesic efficacy of two interscalene blocks and one cervical epidural block in arthroscopic rotator cuff repair
AU - Kim, Jae Yoon
AU - Song, Kwang Sup
AU - Kim, Won Joong
AU - Park, Yong Hee
AU - Kang, Hyun
AU - Woo, Young Cheol
AU - Shin, Hwa Yong
N1 - Funding Information:
This research was supported by Chung-Ang University Research Grants in 2011.
Publisher Copyright:
© 2015, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Purpose: Despite its effectiveness in other surgeries, studies on continuous epidural block in upper-extremity surgery are rare because of technical difficulties and potential complications. This study compared postoperative analgesic efficacy and safety of ultrasound-guided continuous interscalene brachial plexus block (UCISB) and fluoroscopy-guided targeted continuous cervical epidural block (FCCEB) in arthroscopic rotator cuff repair (ARCR). Methods: Seventy-five patients were randomly and equally assigned to groups FCCEB (0.2 %), UCISB75 (0.75 %), and UCISB20 (0.2 %) according to the initial ropivacaine dose (8 ml). The background infusion (0.2 % ropivacaine at 5 ml/h), bolus (3 ml of 0.2 % ropivacaine), and lockout time (20 min) were consistent. Respiratory effects [respiratory discomfort (modified Borg scale), ventilatory function, and hemidiaphragmatic excursion (ultrasound)], analgesic quality [pain severity at rest and motion attempt (VAS-R and -M), number of boluses, analgesic supplements, and sleep disturbance], neurologic effects, procedural discomfort, satisfaction, and adverse effects were evaluated preprocedurally and up to 72 h postoperatively. Results: FCCEB caused less respiratory depression and sensorimotor block, but had less analgesic efficacy than UCISBs (P < 0.05). FCCEB caused nausea, vomiting, and dizziness more frequently (P < 0.05) and had lower patient satisfaction than UCISBs (P < 0.05). UCISB75 can cause severe respiratory distress in patients with lung disorders. Other variables were not significantly different between the groups. Conclusions: UCISB20 may provide superior postoperative analgesia and is the most recommendable postoperative analgesic method in ARCR. Level of evidence: Randomized controlled trials, Therapeutic study, Level I.
AB - Purpose: Despite its effectiveness in other surgeries, studies on continuous epidural block in upper-extremity surgery are rare because of technical difficulties and potential complications. This study compared postoperative analgesic efficacy and safety of ultrasound-guided continuous interscalene brachial plexus block (UCISB) and fluoroscopy-guided targeted continuous cervical epidural block (FCCEB) in arthroscopic rotator cuff repair (ARCR). Methods: Seventy-five patients were randomly and equally assigned to groups FCCEB (0.2 %), UCISB75 (0.75 %), and UCISB20 (0.2 %) according to the initial ropivacaine dose (8 ml). The background infusion (0.2 % ropivacaine at 5 ml/h), bolus (3 ml of 0.2 % ropivacaine), and lockout time (20 min) were consistent. Respiratory effects [respiratory discomfort (modified Borg scale), ventilatory function, and hemidiaphragmatic excursion (ultrasound)], analgesic quality [pain severity at rest and motion attempt (VAS-R and -M), number of boluses, analgesic supplements, and sleep disturbance], neurologic effects, procedural discomfort, satisfaction, and adverse effects were evaluated preprocedurally and up to 72 h postoperatively. Results: FCCEB caused less respiratory depression and sensorimotor block, but had less analgesic efficacy than UCISBs (P < 0.05). FCCEB caused nausea, vomiting, and dizziness more frequently (P < 0.05) and had lower patient satisfaction than UCISBs (P < 0.05). UCISB75 can cause severe respiratory distress in patients with lung disorders. Other variables were not significantly different between the groups. Conclusions: UCISB20 may provide superior postoperative analgesia and is the most recommendable postoperative analgesic method in ARCR. Level of evidence: Randomized controlled trials, Therapeutic study, Level I.
KW - Analgesia
KW - Arthroscopes
KW - Brachial plexus
KW - Epidural
KW - Rotator cuff
UR - http://www.scopus.com/inward/record.url?scp=84959252517&partnerID=8YFLogxK
U2 - 10.1007/s00167-015-3667-8
DO - 10.1007/s00167-015-3667-8
M3 - Article
C2 - 26063452
AN - SCOPUS:84959252517
SN - 0942-2056
VL - 24
SP - 931
EP - 939
JO - Knee Surgery, Sports Traumatology, Arthroscopy
JF - Knee Surgery, Sports Traumatology, Arthroscopy
IS - 3
ER -