CONTINUOUS INTERSCALENE BLOCK (CISB) ASSISTED BY ULTRASOUND IN OUTPATIENT SHOULDER SURGERY
M Fredrickson, A Dalgleish, C Ball
University of Auckland, Auckland, New Zealand
Purpose of Study
CISB following shoulder surgery has been shown to provide better analgesia and patient satisfaction than opioid analgesia (1). Ultrasound (US) guidance for peripheral nerve block is growing in popularity, but experience with the use of US to assist ISB is limited to case reports (2). We sought to assess the effectiveness and complications of an interscalene catheter (ISC) routinely placed using US-assistance in patient’s having ambulatory CISB following elective shoulder surgery.
Method
Following institutional review board approval and informed consent, 60 patients in a private practice setting were included. Prior to surgery, with US guidance (Sonosite 180®) then nerve stimulation, an ISC was placed in the interscalene space at C6. Lignocaine 2% 0.25ml/kg and later ropivacaine 0.5% 0.25ml/kg was administered via the ISC. Following surgery, ropivacaine 0.2% 2ml/hr with an hourly on demand 5ml bolus was administered via an elastomeric pump (PainBuster®). Discharge occurred on the day of surgery or first post-operative morning.
Result
43% had rotator cuff surgery. 55 (91%) had an initial verbal analogue pain score (VAS) in PACU of ? 2. A further 4 achieved a VAS of ? 2 following 1 cm withdrawal of the ISC and administration of 20ml 0.5% ropivacaine. One patient required ISC replacement. The worst VAS’s throughout the treatment were very low (Table 1) and only 3 patients required post-operative opioids, one for persistent shivering in PACU, one for T2 dermatome pain (axillary incision) and one for ISC failure at home. ISC’s were self-removed after a mean 3.9 days and no patient developed ISC infection. There were no new neurological symptoms beyond day 21.
Conclusion
In our setting, US-assisted ISC placement was associated with excellent analgesia and high patient satisfaction. There was a low incidence of complications and catheter failure.
Anesthesiology'97;87:1343 (2) RAPM'03;28:3
Table 1. Post-Operative Pain
| First post-operative night | Day 1 until catheter removal (mean 3.9 days) | ||
| Worst VAS at any time | Worst Post-Bolus VAS | Worst VAS at any time | Worst Post-Bolus VAS |
| 2.3 (1.8) | 0.5 (1.0) | 3.8 (1.8) | 1.3 (1.0) |
Legend: Data presented as Verbal Analogue Pain Score (VAS) mean (SD)
Time of Presentation:
Sunday 14 May 2006 - 1030-1200
