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Analgesic Effect of Interscalene Block Using Low-Dose Bupivacaine for Outpatient Arthroscopic Shoulder Surgery
  1. A. Al-Kaisy, F.R.C.A.,
  2. G. McGuire, M.D.,
  3. V. W.S. Chan, F.R.C.P.C.,
  4. G. Bruin, F.R.C.P.C.,
  5. P. Peng, F.R.C.P.C.,
  6. A. Miniaci, F.R.C.P.S.C. and
  7. A. Perlas, M.D.
  1. From the Departments of Anesthesia, and Surgery, University of Toronto, The Toronto Hospital, Western Division, Toronto, Ontario, Canada.
  1. Reprint requests: Vincent Chan, M.D., Department of Anesthesia, University of Toronto, The Toronto Hospital, Western Division, 399 Bathurst Street, Toronto, Ontario, Canada, M5T 2S8.

Abstract

Background and Objectives Although interscalene brachial plexus block (ISBPB) is often used to provide anesthesia for arthroscopic shoulder surgery, its selective analgesic effect, provided by low-dose local anesthetic, has not been studied. We hypothesized that ISBPB using a low volume and low concentration of bupivacaine can provide effective postoperative analgesia for shoulder surgery without producing significant sensory or motor block elsewhere.

Methods In this double-blind study, 30 outpatients scheduled to undergo shoulder arthroscopy were randomly assigned to receive either an ISBPB with 10 mL 0.125% bupivacaine with epinephrine 1:400,000 (n = 15) or 10 mL of normal saline (n = 15). The block was performed preoperative, prior to a standardized general anesthetic. Postoperative pain scores, morphine and oral analgesic consumption, recovery profile, and patient satisfaction were recorded.

Results In the ISBPB group, verbal analog pain scores within 120 minutes after surgery were lower, morphine consumption in the postanesthesia care unit was significantly lower (2.7 ± 2.6 mg vs 9.5 ± 5.2 mg), the time to postoperative administration of the first systemic or oral analgesic was significantly longer (141 ± 182 minutes vs 13 ± 10 minutes), the degree of motor and sensory block 120 minutes after surgery was minimal, time to reach hospital discharge criteria was earlier, and patient satisfaction with postoperative analgesia at 24-hour follow-up was greater. Thirty-three percent of the patients receiving ISBPB did not require any analgesic prior to hospital discharge.

Conclusions Interscalene brachial plexus block with low-dose bupivacaine is a useful and selective analgesic technique for outpatient shoulder arthroscopic surgery.

  • interscalene brachial plexus block
  • bupivacaine
  • outpatient shoulder arthroscopy

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Footnotes

  • This article was presented at the Annual Meeting of the Society of Ambulatory Anesthesia, Orlando, Florida, 1997. This study was supported in part by a grant from Sanofi Winthrop Canada.

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