scholarly journals The Efficacy of Additional Intravenous Patient-controlled Analgesia to the Interscalene Block in Arthroscopic Shoulder Surgery: A Prospective Randomized Controlled Study

2017 ◽  
Vol 20 (1) ◽  
pp. 10-17
Author(s):  
Sang-Jin Shin ◽  
Myeong-Jae Seo ◽  
Youn Jin Kim ◽  
Hee Jung Baik
Keyword(s):  
Shoulder Surgery ◽  
Interscalene Block ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Patient Controlled Analgesia ◽  
Randomized Controlled ◽  
Arthroscopic Shoulder Surgery

scholarly journals Comparison of Diaphragmatic Paralysis, Respiratory Function and Postoperative Pain After Interscalene Brachial Plexus Block With a Reduction Dose of Levobupivacaine 0.25% 10 ml Versus 20 ml Undergoing Arthroscopic Shoulder Surgery: Study Protocol for the Randomized, Controlled and Double-blinded REDOLEV Study.

2020 ◽  
Author(s):  
Pablo Oliver-Fornies ◽  
Pablo Ortega Lahuerta ◽  
Roberto Gomez Gomez ◽  
Inmaculada Gonzalo Pellicer ◽  
Leticia Oliden Gutierrez ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Shoulder Surgery ◽  
Patient Controlled Analgesia ◽  
Interscalene Brachial Plexus Block ◽  
Randomized Controlled ◽  
Arthroscopic Shoulder Surgery ◽  
Low Volume ◽  
Plexus Block

Abstract Background: Arthroscopic shoulder surgery involves dynamic and severe postoperative pain. Interscalene brachial plexus block provides adequate analgesia, but the spread of local anaesthetics administered causes a phrenic nerve block that entrains a nonnegligible incidence of hemidiaphragmatic paralysis acute.The main objective of this trial is to compare the hemidiaphragmatic paralysis after interscalene brachial plexus block in arthroscopic shoulder surgery, between a standard volume (20 ml) and a low volume (10 ml) of 0.25% levobupivacaine.Methods: This is a comparative, prospective, single-center, double-blind, two-arm randomized controlled trial. Forty-eight patients will be included. The primary end-point is to determine the hemidiaphragmatic paralysis incidence diagnosed by the diaphragmatic thickness ratio in ultrasound. The secondary endpoints are as follows: (1) hemidiaphragmatic paralysis incidence diagnosed by forced vital capacity and (2) forced expiratory volume at 1 second decrease in spirometry; (3) hemidiaphragmatic paralysis incidence diagnosed by using diaphragmatic excursion decrease in ultrasound; (4) postoperative pain regarding 24-hour morphine intravenous total consumption and (5) time to first analgesic consumption of patient-controlled analgesia pump; and (6) postoperative harm between the two trial arms.Discussion: This trial would demonstrate that low-volume interscalene brachial plexus block decreases hemidiaphragmatic paralysis in arthroscopic shoulder surgery by using spirometry and ultrasound and would not provide inferior postoperative analgesia according to opioid requirements of postoperative patient-controlled analgesia in comparison to the standard volume used in current practice.Trial registration: EudraCT and Spanish Trial Register (REec) registration number: 2019-003855-12 (Registered on 07 January 2020). ClinicalTrials.gov identification number: NCT04385966 (Retrospectively registered on 08 May 2020). Ethics Committee approval: EC19/093 (18 Dic 2019).

scholarly journals Comparison of Dexmedetomidine and Dexamethasone as Adjuvants to Ultra-Sound Guided Interscalene Block in Arthroscopic Shoulder Surgery: A Double-Blinded Randomized Placebo-Controlled Study

2021 ◽  
Vol 11 (3) ◽  
Author(s):  
Roman Margulis ◽  
Jacquelyn Francis ◽  
Bryan Tischenkel ◽  
Adam Bromberg ◽  
Domenic Pedulla ◽  
...  
Keyword(s):  
Shoulder Surgery ◽  
Opioid Consumption ◽  
Sensory Function ◽  
Interscalene Block ◽  
Ultra Sound ◽  
Controlled Study ◽  
Control Group ◽  
Dexamethasone Group ◽  
Arthroscopic Shoulder Surgery ◽  
First Pain

Background: Interscalene block is one of the popular methods for decreasing pain and analgesic consumption after shoulder arthroscopic surgeries. Objectives: The objective is to compare the analgesic duration of effects of dexmedetomidine and dexamethasone as adjuvants to 0.5% ropivacaine in ultrasound-guided interscalene blocks for arthroscopic shoulder surgery in an ambulatory setting. Methods: In this randomized controlled trial, 117 adult patients candidate for ambulatory arthroscopic shoulder surgery under general anesthesia were divided into three groups to perform an ultra-sound guided interscalene block before the surgery. The ropivacaine (control) group received ropivacaine 0.5% 20 mL, group Dexamethasone received ropivacaine 0.5% 20 mL plus 4mg dexamethasone, and group dexmedetomidine received ropivacaine 0.5% 20 mL plus 75 mcg of dexmedetomidine. Time to return of sensory function, of motor function, of first pain sensation, amount of opioid medication consumed at 24 hours and 48 hours post-operatively were measured. Results: The 24-hour median (25th- 75th percentile) opioid consumption in morphine equivalents was similar between groups 22.5 mg (10 - 30), 15 mg (0 - 30), and 15 mg (0 - 20.6) in the ropivacaine, dexmedetomidine, and dexamethasone groups, respectively (P = 0.130). The median (25th- 75th percentile) 48 hours post-operatively, the median opioid consumption in morphine equivalents was 40 mg (25 - 67.5) in the ropivacaine group, 30 mg (22 - 50.6) in the dexamethasone group, and 52.5 mg (30 - 75) in the dexmedetomidine group (P = 0.278). The median 24-hour pain scores were 6 (5 - 8) in the ropivacaine control group, 7 (5.5 - 8) in the dexamethasone group, and 7 (4 - 9) in the dexmedetomidine group (P = 0.573). Conclusions: There was no statistical difference in opioid consumption at 24 and 48 hours post-operatively when comparing dexmedetomidine, dexamethasone, and no adjuvant. However, intraoperative opioid use was significantly lower with dexmedetomidine compared to dexamethasone and plain 0.5% ropivacaine. The safe side effect profile of dexmedetomidine makes it a reasonable alternative as an adjuvant for peripheral nerve blockade when dexamethasone use may be contraindicated.

Sign in / Sign up

Export Citation Format

Share Document