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The investigators compared the postoperative analgesia of nerve stimulator-guided and ultrasound-guided interscalene block after shoulder surgery.
Ultrasound (US)-guided peripheral nerve block has increased in popularity. It has many advantages such as improved success rate, faster onset time, fewer needle passes, shorter performance time, and reduced procedural pain and vascular puncture. However, there is no information about postoperative analgesia.
Therefore, the investigators tested whether nerve stimulator (NS) - guided interscalene block was inferior to ultrasound-guided block in terms of duration of postoperative analgesia for shoulder surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| NS-guided interscalene block | Active Comparator | NS-guided interscalene block is performed using 20 ml of 0.75% ropivacaine. |
|
| US-guided interscalene block | Experimental | US-guided interscalene block is performed using 20 ml of 0.75% ropivacaine. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| NS-guided interscalene block | Procedure | Patients received a standard single injection interscalene block using the modified lateral approach of Borgeat. The interscalene brachial plexus was identified using an insulated needle connected to a nerve stimulator. An insulated needle attached to a nerve stimulator was used to identify the brachial plexus. Placement of the needle was considered adequate if the deltoid, triceps, pectoralis, or biceps muscle motor response was still present at 0.2 - 0.5mA. Ropivacine 0.75% 20ml was used. |
| Measure | Description | Time Frame |
|---|---|---|
| duration of postoperative analgesia | time from completion of local anesthetic injection until the first request for an analgesic | at 24h after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| onset time (complete block of sensory and motor nerve) | complete block of sensory and motor nerve | until 30min after completion of local anesthetic |
| patient discomfort (pain score (0 -10) during the procedure) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Chunwoo Yang, MD | Dep. of anesthesia and pain medicine, Cheju Halla General Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cheju Halla General Hopsital | Jeju City | Jeju Special Governing Province | 670-744 | South Korea |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25376973 | Result | Choi S, McCartney CJ. Evidence Base for the Use of Ultrasound for Upper Extremity Blocks: 2014 Update. Reg Anesth Pain Med. 2016 Mar-Apr;41(2):242-50. doi: 10.1097/AAP.0000000000000155. | |
| 18477070 | Result | Koscielniak-Nielsen ZJ. Ultrasound-guided peripheral nerve blocks: what are the benefits? Acta Anaesthesiol Scand. 2008 Jul;52(6):727-37. doi: 10.1111/j.1399-6576.2008.01666.x. Epub 2008 May 12. |
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| ID | Term |
|---|---|
| D010146 | Pain |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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|
| US-guided interscalene block | Procedure | Interscalene block is performed under ultrasound guidance. Linear probe is placed on the ipsilateral interscalene groove visualizing the brachial plexus located between anterior and middle scalene muscles. Using in-plane technique, an insulated needle is advanced into the brachial plexus sheath, into which 20 ml of 0.75% ropivacaine is injected |
|
pain score (0 -10) during the procedure
| at 30 min after block placement |
| block performance time (the time between the block needle insertion and needle withdrawal) | the time between the block needle insertion and needle withdrawal. | at 30 min after block placement |
| The number of needle redirections | either forward or backward movement of needle at least 1 cm or more | at 30 min after block placement |
| paresthesia (presence of paresthesia during the procedure) | presence of paresthesia during the procedure | at 30 min after block placement |
| motor block of hand | degree of motor block in the operated hand | at 30 min after block placement |
| paresthesia of hand | presence of paresthesia in the operated hand | at 30 min after block placement |
| Supplemental analgesia | at 24h after surgery |
| Pain score | numerical rating scale (0 - 10) | at 24h after surgery |
| Patient satisfaction | Patient satisfaction was evaluated using a two-point score: 1, satisfactory (if necessary, I would have the same anesthetic technique); and 2, unsatisfactory (different anesthetic technique). | at 24h after surgery |