Analgesic efficacy of two interscalene blocks and one cervical epidural block in arthroscopic rotator cuff repair

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.