None listed
Conditions
Brief summary
Acute postoperative pain is commonly severe after major shoulder surgery - with opioids being required for several days. There is increasing evidence that poorly treated acute postoperative pain is a predictor of chronic pain and therefore chronic disability. Further, evidence exists that preventing early postoperative pain reduces the risk of chronic pain. Continuous interscalene block (CISB) has been shown to provide better analgesia and patient satisfaction than opioids for rotator cuff surgery. It has also been shown to improve patient outcome. CISB has been successfully used in Auckland for 4 years, however, anaesthetists have had to base many aspects of the technique on personal opinion rather than evidence from high quality research. Although CISB has been shown to provide better analgesia and patient satisfaction than opioids for rotator cuff repair, it is unknown whether these benefits apply to less painful procedures such as arthroscopic stabilization and arthroscopic subacromial decompression. For both procedures, randomized trials comparing CISB with traditional opioid analgesia have not been conducted. The purpose of the current study is to determine whether CISB provides better analgesia and patient satisfaction than traditional single shot interscalene block (the community standard) following minor shoulder procedures (subacromial decompression and stabilisation). If the primary hypothesis is confirmed, this study will provide evidence supporting the use of continuous interscalene block for this surgery. This may result in future patients experiencing less postoperative pain after minor shoulder surgery. Potential benefits might include a lower incidence of post shoulder surgery chronic pain.
Interventions
Interscalene block
A single operator Dr Michael Fredrickson (MF) will place all interscalene catheters (ISCs) in the operating room. Patients will be premedicated with oral acetaminophen 1 g, diclofenac SR 75 mg and omeprazole 20 mg one hour before surgery. Intravenous midazolam 2 mg, alfentanil 0.5 mg and cephazolin 1 g will be administered 5 min prior to interscalene catheter placement. Catheters will be placed following either the administration of a superficial cervical plexus block (SCPB) o
Interscalene block A single operator Dr Michael Fredrickson (MF) will place all interscalene catheters (ISCs) in the operating room. Patients will be premedicated with oral acetaminophen 1 g, diclofenac SR 75 mg and omeprazole 20 mg one hour before surgery. Intravenous midazolam 2 mg, alfentanil 0.5 mg and cephazolin 1 g will be administered 5 min prior to interscalene catheter placement. Catheters will be placed following either the administration of a superficial cervical plexus block (SCPB) or after the induction of general anaesthesia depending on patient preference. ISCs will be placed using a combination of ultrasound and nerve stimulation. General anaesthesia will then be administered and ropivacaine 0.5% 0.5 mL/kg to a maximum of 30 mL will be administered through the ISC. Continuous block patients will then receive an ambulatory infusion of ropivacaine 0.2% at the end of surgery.
Sponsors
Dr Michael Fredrickson
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
0 to No maximum
Healthy volunteers
Yes
Inclusion criteria
Patients undergoing elective minor shoulder surgery under the anaesthetic care of the principal investigator.
Exclusion criteria
1. Patient refusal / inability to consent, age no limits 2. Allergy amide local anaesthetic (LA) drugs 3. Existing neurological disorders / neuropathy of the operative extremity 4. Infection at site of needle puncture 5. Severe respiratory disease 6. Chronic opioid therapy 7. Patients intolerant of all non-steroidal anti-inflammatory drugs (NSAID).
Outcome results
None listed