Continuous Interscalene Block in Patients Having Outpatient Rotator Cuff Repair Surgery: A Prospective Randomized Trial

Salviz, Emine Aysu MD*; Xu, Daquan MD*; Frulla, Ashton*; Kwofie, Kwesi MD, FRCPC*; Shastri, Uma MD, FRCPC*; Chen, Junping MD*; Shariat, Ali Nima MD*; Littwin, Sanford MD*; Lin, Emily MD, PhD*; Choi, Jason MD*; Hobeika, Paul MD; Hadzic, Admir MD, PhD*

Anesthesia & Analgesia:
doi: 10.1213/01.ane.0000436607.40643.0a
Pain Medicine: Research Report
Abstract

BACKGROUND: We performed this randomized trial to compare the recovery profile of patients receiving single injection (SISB) and continuous interscalene brachial plexus block (CISB) or general anesthesia (GA) for arthroscopic rotator cuff repair surgery through the first postoperative week. Our primary hypothesis was that the highest pain numeric rating scale (NRS) (worst pain score) at the end of the study week would be lower for patients in the CISB group than for patients in the SISB or GA groups.

METHODS: Seventy-one patients scheduled for elective outpatient arthroscopic rotator cuff repair were enrolled. CISB patients received 20 mL of 0.5% ropivacaine as a bolus through a catheter, whereas SISB patients received the same injection volume through a needle. CISB patients received an infusion of 0.2% ropivacaine at 5 mL/h with a patient-controlled bolus of 5 mL hourly for 48 hours. GA-only patients received a standardized general anesthetic. Postoperative highest NRS pain scores through the first postoperative week, time-to-first pain, analgesic consumption, fast-tracked postoperative anesthesia care unit (PACU) bypass rate, length of PACU stay, time-to-discharge home, total hours of sleep, and related adverse effects were recorded in the PACU and at home on postoperative days 1, 2, 3, and 7.

RESULTS: No patient in the CISB or SISB groups reported a NRS ≥1 or required analgesics while in the PACU. While most patients in the CISB and SISB groups were fast-tracked to PACU discharge, no patient in the GA group was fast-tracked (Χ2 P = 0.003). Length of stay in the PACU was significantly shorter for the CISB and SISB groups than for the GA group (20 ± 31, 30 ± 42, and 165 ± 118 minutes, respectively (CISB vs GA, P < 0.001; SISB vs GA, P <0.001), and time-to-discharge home was significantly shorter when compared with the GA group. Time to first pain report was longer in the CISB group. Mean NRS scores were lower for patients in the CISB group than in the SISB and GA groups on postoperative days 1 and 2, and use of narcotics (doses ≥1) was lower until postoperative day 3. Patients who received CISB slept significantly longer than patients who received SISB or GA (P < 0.01) during the first 48 hours postoperatively. By the end of the study week, 26% of patients in the CISB group, 83% in the SISB group, and 58% of GA patients reported NRS ≥4 (both P-values ≤ 0.05).

CONCLUSION: The analgesic benefits of CISB found in the PACU and immediately after discharge extend through the intermediate recovery period ending on postoperative day 7.

Author Information

From the Departments of *Anesthesiology and Orthopedics, St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York.

Emine Aysu Salviz, MD, is currently affiliated with Department of Anesthesiology, Istanbul University, Medical School of Istanbul, Istanbul, Turkey; Ashton Frulla is currently affiliated with Department of Cardiac Electrophysiology, Columbia University Medical Center, New York, New York; Kwesi Kwofie, MD, FRCPC, is currently affiliated with Department of Anesthesiology, Dalhousie University, Nova Scotia, Canada; and Uma Shastri is currently affiliated with Department of Anesthesiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada.

Accepted for publication August 29, 2013.

Funding: Baxter Healthcare Corporation, Deerfield, IL and Departmental Sources of St. Luke’s-Roosevelt Hospital Center.

Conflict of Interest: See Disclosures at the end of the article.

Reprints will not be available from the authors.

Address correspondence to Admir Hadzic, MD, PhD, Department of Anesthesiology, St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons. 1111 Amsterdam Ave., New York, NY 10025. Address e-mail to admir@nysora.com.

© 2013 International Anesthesia Research Society