Continuous interscalene brachial plexus blockade provides good analgesia at home after major shoulder surgery: report of four cases

• Published in: Canadian journal of anesthesia Vol. 50; no. 1; pp. 57 - 61
• Main Authors: NIELSEN, Karen C, GREENGRASS, Roy A, PIETROBON, Ricardo, KLEIN, Stephen M, STEELE, Susan M
• Format: Journal Article
• Language: English
• Published: Toronto, ON Canadian Anesthesiologists' Society 2003; Springer Nature B.V
• Subjects: Aged; Ambulatory Surgical Procedures; Analgesia, Patient-Controlled - instrumentation; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Brachial Plexus; Catheterization - instrumentation; Catheters; Cognitive ability; Cost control; Home Care Services, Hospital-Based; Humans; Infusion Pumps; Local anesthesia. Pain (treatment); Medical sciences; Middle Aged; Nausea; Nerve Block - adverse effects; Nerve Block - instrumentation; Patient satisfaction; Questionnaires; Rotator Cuff - surgery; Shoulder; Surgery; Time Factors; Human; Postoperative; Continuous; Brachial plexus; Diseases of the osteoarticular system; Blocking; Ropivacaine; Pump; Local anesthetic; Case study; Analgesia; Regional anesthesia; Pain; Perfusion; Surgery; Shoulder; At home; Surgical approach; Organic amide; Ambulatory
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/BF03020188

Continuous interscalene brachial plexus blockade (CIBPB) in a hospital setting can provide excellent surgical conditions and postoperative analgesia for major shoulder surgery. This is a case report of four patients on the efficacy and advantages of CIBPB for postoperative analgesia at home. Four patients scheduled for rotator cuff repair under CIBPB were discharged home the day of surgery with an interscalene catheter connected to an automated infusion pump administering 0.2% ropivacaine at 10 mL x hr(-1) for 72 hr. Prior to discharge, patients and their attendant were given verbal and written instructions concerning local anesthetic toxicity and explicit contact information for an anesthesiologist or nurse. Outcomes were measured pre- and postoperatively, including verbal analogue pain scores (pain VAS), verbal analogue nausea scores (nausea VAS), side effects, cognitive function (mini-mental state questionnaire), sleep (hours/night), and patient satisfaction (Likert scale). Postoperative VAS scores over three days were very low. Two patients reported only one episode of nausea. There were no complications associated with local anesthetic toxicity or catheter use. Cognitive function improved over three days. Sleep increased from a mean of five hours before surgery to seven hours over the next three nights. Patient satisfaction with care was high. Significant cost savings were documented. The use of CIBPB for 72 hr in patients undergoing major ambulatory shoulder surgery can result in good analgesia with minimal opioid requirement, cost savings and possibly improvement in outcome measures.