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Analgesic Effects of Low-Dose Ropivacaine for Interscalene Brachial Plexus Block for Outpatient Shoulder Surgery—A Dose-Finding Study
  1. Susanne C. Krone, F.R.C.A.,
  2. Vincent W.S. Chan, M.D., F.R.C.P.C.,
  3. Joan Regan, F.F.A.R.C.S.I.,
  4. Philip Peng, M.B.B.S., F.R.C.P.C.,
  5. Eileen M. Poate, F.F.A.R.C.S.I.,
  6. Colin McCartney, M.B.Ch.B., F.F.A.R.C.S.I., F.R.C.A. and
  7. Anthony Miniaci, M.D., F.R.C.P.S.C.
  1. From the Departments of Anesthesia (S.C.K., V.W.S.C., J.R., P.P., E.M.P., C.M.) and Surgery (A.M.), University of Toronto, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.
  1. Reprint requests: Vincent W.S. Chan, M.D., F.R.C.P.C., Department of Anesthesia, University of Toronto, Toronto Western Hospital, 399 Bathurst St, Toronto, Ontario, Canada M5T 2S8. E-mail: vincentchan{at}compuserve.com

Abstract

Background and Objectives Interscalene brachial plexus block (ISB) with low-dose bupivacaine provides effective postoperative shoulder analgesia in outpatients. The analgesic effect of low-dose ropivacaine for ISB is unknown.

Methods In this double-blind study, 66 outpatients scheduled to undergo arthroscopic shoulder surgery were randomly assigned to receive an ISB with 10 mL of 0.125%, 0.25%, or 0.5% ropivacaine before surgery. Postoperative verbal pain rating score, analgesic consumption, and the extent of motor and sensory block was assessed for 120 minutes after surgery.

Results The degree of shoulder analgesia was dose dependent. Postoperative pain scores were lowest with 0.5% ropivacaine, and analgesic was not required in the hospital in 70% of the patients who received 0.25% and 0.5% ropivacaine, compared to 30% with 0.125% ropivacaine (P < .03). In the patients who required no analgesic in the hospital, the time to first oral analgesic at home was approximately 10 hours irrespective of ropivacaine concentration. Motor and sensory block distal to the elbow was detected in 25% of the patients in the 0.5% group but none in the 0.125% group.

Conclusions Interscalene brachial plexus block with low-dose ropivacaine, 10 mL of 0.25% and 0.5%, provides effective long-lasting shoulder analgesia in a majority of patients after arthroscopic surgery.

  • Interscalene brachial plexus block
  • Local anesthetics
  • Ropivacaine
  • Surgery
  • outpatient
  • Shoulder arthroscopy
  • Analgesia
  • postoperative

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Footnotes

  • Presented at International Symposium on Regional Anesthesia & Pain Medicine, May 31, 2000, Quebec City, Quebec, Canada.

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