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Continuous interscalene brachial plexus block: clinical efficacy, technical problems and bupivacaine plasma
M Tuominen1, J Haasio, R Hekali
1Department of Anaesthesia, Helsinki University Central Hospital, Finland.
Acta Anaesthesiologica Scandinavica
|January 1, 1989
Summary
Continuous interscalene brachial plexus block using bupivacaine provided effective analgesia for shoulder surgery. Most patients required minimal or no additional pain relief, with low bupivacaine levels and increased protein binding reducing toxicity risk.
Area of Science:
- Anesthesiology
- Pain Management
- Regional Anesthesia
Background:
- Shoulder surgery often requires effective postoperative pain management.
- Continuous interscalene brachial plexus block is a technique for regional analgesia.
Purpose of the Study:
- To evaluate the efficacy and safety of continuous interscalene brachial plexus block with bupivacaine for shoulder surgery analgesia.
Main Methods:
- 24 patients received a single dose of 0.5% bupivacaine followed by a continuous infusion.
- General anesthesia drugs included glycopyrrolate, thiopentone, vecuronium, enflurane, and N2O/O2.
- Plasma bupivacaine concentrations and alpha 1-acid glycoprotein (AAG) levels were monitored.
Main Results:
- All patients achieved regional analgesia without immediate hemodynamic issues.
- Catheter dysfunction occurred in 6 patients; of the remaining 18, 9 needed no additional analgesics.
- Common side effects included hand numbness and hoarseness; plasma bupivacaine levels remained low, with increased AAG potentially reducing toxicity.
Conclusions:
- Continuous interscalene brachial plexus block with bupivacaine is effective for shoulder surgery pain.
- Low free bupivacaine levels and increased AAG suggest a favorable safety profile.
- Catheter fixation is recommended to prevent displacement.