None listed
Conditions
Brief summary
Rotator cuff surgery ranks in the top 3 procedures performed according to Accident Compensation Commission records. Arthroscopic rotator cuff surgery is becoming more common as surgeons skills and techniques become better.However pain relief following an arthroscopic rotator cuff repair can be problematic. A number of different techniques have been described to overcome this problem. The one conventionally used is an interscalene block whereby the nerves at the base of the neck receive a local anaesthetic injection. The patient is then given IV/oral analgesics once the block has worn off. The main issues are that 1. sometimes the block does not work (ie.. does not provide pain relief/control) and 2. sometimes the patients get concerned that the block fails to resolve (ie.. they are left with a short-term almost paralysis type picture) and makes movements and sensation of the affected arm difficult for the patient.There is no accepted consensus on which technique is best, however, recently devices have become available which infuse the anaesthetic directly into the shoulder joint. The results both locally and internationally although anecdotal (no scientific paper has compared the two techniques) are promising and may lead to better and more effective pain control as well as taking away the patients concern regarding there non-functioning arm.We will be undertaking the first project to compare the traditional technique against a direct local anaesthetic infusion pump. We feel that the potential health outcomes from this new technique for pain control, may change what is now considered standard treatment. It may even become practical for use in other areas of Arthroscopy such as the knee, ankle, elbow or wrist Our hypothesis is that there is an advantage in terms of post op pain relief with the use of a Breg Pain Pump with a short acting brachial plexus block compared to a long acting brachial plexus block. We will be doing this by using a visual analogue score for the patients to see whether there is any statistical significant difference between group 1 (those who will be receiving a short acting inter-scalene block and subacromial infusion pump) compared with group 2 (those who will receive a long-acting inter-scalene block)
Interventions
Prospective Randomised Control Trial
Patients undergoing an arthroscopic rotator cuff repair by Simon McMahon with the anaesthetic given by John Hyndman at Mercy Hospital, Dunedin, New Zealand will be eligible for enrolment in the study
After patients have given there consent to being in the study they will be randomised into Group 1 or 2
Randomisation will occur through a random generated number table
Group 2 (CONTROL): Those who will receive a long-acting inter-scalene block + IV/oral analg
Prospective Randomised Control Trial Patients undergoing an arthroscopic rotator cuff repair by Simon McMahon with the anaesthetic given by John Hyndman at Mercy Hospital, Dunedin, New Zealand will be eligible for enrolment in the study After patients have given there consent to being in the study they will be randomised into Group 1 or 2 Randomisation will occur through a random generated number table Group 2 (CONTROL): Those who will receive a long-acting inter-scalene block + IV/oral analgesia Bupivacaine 0.375% 20-30mls (depending patients weight) After patients have given their consent to being in the study they will be randomised Patients will be asked to record their level of pain by 1. using a visual analogue scale (VAS) on paper VAS = visual scale 100mm’s in length with no pain at the left hand side and worst pain ever experienced at the right hand side. Patients will be asked subjectively to place a mark on the line where they feel there level of pain is at there pre-operative assessment, and then 4, 8, 12, 24, 48 hours post-operation. Any analgesics consumed at these times will also be recorded
Sponsors
Nigel Hartnett
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. All patients with a rotator cuff tear / arthropathy at Mercy Hospital who will2. undergo arthroscopic rotator cuff repair by Simon McMahon 3. be anaesthetised by John Hyndman4. All patients who wish to participate in the study and give consent to being in the study.
Exclusion criteria
Those patients not able to give consent. Those patients who are sensitive or allergic to the medications given. Those patients who do not wish to participate and/or who do not give consent to being in the study.
Outcome results
None listed