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Interscalene brachial plexus analgesia after open shoulder surgery: continuous versus patient-controlled infusion
F J Singelyn1, S Seguy, J M Gouverneur
1Department of Anesthesiology, Université Catholique de Louvain School of Medicine, St Luc Hospital, Brussels, Belgium. Singelyn@anes.ucl.ac.be
Anesthesia and Analgesia
|November 30, 1999
Summary
Continuous interscalene analgesia after shoulder surgery requires a background infusion for effective pain management. A combination of a basal infusion and patient-controlled analgesia (PCA) boluses is recommended for optimal results.
Area of Science:
- Anesthesiology
- Pain Management
- Regional Anesthesia
Background:
- Open shoulder surgery often results in significant postoperative pain.
- Effective pain management is crucial for patient recovery and early mobilization.
Purpose of the Study:
- To evaluate the efficacy of different patient-controlled analgesia (PCA) regimens for continuous interscalene analgesia after open shoulder surgery.
- To determine the optimal infusion strategy for interscalene analgesia.
Main Methods:
- Prospective, randomized, double-blinded study involving 60 patients undergoing open shoulder surgery.
- Three groups received different combinations of continuous interscalene infusion and PCA boluses of bupivacaine, sufentanil, and clonidine over 48 hours.
- Pain scores, sensory block, supplemental analgesia, drug consumption, side effects, and patient satisfaction were assessed.
Main Results:
- Continuous infusion with PCA (Group 2) and continuous infusion alone (Group 1) provided significantly better sensory block and pain control than PCA alone (Group 3) at 24 and 48 hours.
- Group 3 required more supplemental paracetamol.
- Local anesthetic consumption was lower in Groups 2 and 3 compared to Group 1.
- Patient satisfaction was higher in Groups 1 and 2.
Conclusions:
- Continuous interscalene analgesia necessitates a background infusion for efficient pain relief post-open shoulder surgery.
- A regimen combining a basal infusion rate of 5 mL/h with PCA boluses (2.5 mL/30 min) is recommended for optimal pain management and patient satisfaction.