This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nielsen, K. C. Articles by Steele, S. M. Search for Related Content PubMed PubMed Citation Articles by Nielsen, K. C. Articles by Steele, S. M.

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

[Le blocage interscalène continu du plexus brachial fournit une bonne analgésie à domicile après une opération majeure à l’épaule – observation de quatre cas]

Karen C. Nielsen, MD^*, Roy A. Greengrass, MD FRCP^*, Ricardo Pietrobon, MD^*,, Stephen M. Klein, MD^* and Susan M. Steele, MD^*

^* From the Departments of Anesthesiology, and
Surgery Duke, University Medical Center, Durham, North Carolina USA.

Address correspondence to: Dr. Karen C. Nielsen, Department of Anesthesiology, Box 3094, Duke University Medical Center, Durham, NC 27710, USA. Phone: 919-668-2051; Fax: 919-668-2081; E-mail: niels006{at}mc.duke.edu

Purpose: 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.

Case reports: 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•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.

Conclusion: 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.

This article has been cited by other articles:

				S. M. Klein, H. Evans, K. C. Nielsen, M. S. Tucker, D. S. Warner, and S. M. Steele Peripheral Nerve Block Techniques for Ambulatory Surgery Anesth. Analg., December 1, 2005; 101(6): 1663 - 1676. [Abstract] [Full Text] [PDF]

				A. T. Wilson, E. Nicholson, L. Burton, and C Wild Analgesia for day-case shoulder surgery Br. J. Anaesth., March 1, 2004; 92(3): 414 - 415. [Abstract] [Full Text] [PDF]