Analgesic efficacy of two interscalene blocks and one cervical epidural block in arthroscopic rotator cuff repair

Abstract

Despite its effectiveness in other surgeries, studies on continuous epidural block in upper-extremity surgery are rare because of technical difficulties and potential complications. This study compared postoperative analgesic efficacy and safety of ultrasound-guided continuous interscalene brachial plexus block (UCISB) and fluoroscopy-guided targeted continuous cervical epidural block (FCCEB) in arthroscopic rotator cuff repair (ARCR). Seventy-five patients were randomly and equally assigned to groups FCCEB (0.2 %), UCISB75 (0.75 %), and UCISB20 (0.2 %) according to the initial ropivacaine dose (8 ml). The background infusion (0.2 % ropivacaine at 5 ml/h), bolus (3 ml of 0.2 % ropivacaine), and lockout time (20 min) were consistent. Respiratory effects [respiratory discomfort (modified Borg scale), ventilatory function, and hemidiaphragmatic excursion (ultrasound)], analgesic quality [pain severity at rest and motion attempt (VAS-R and -M), number of boluses, analgesic supplements, and sleep disturbance], neurologic effects, procedural discomfort, satisfaction, and adverse effects were evaluated preprocedurally and up to 72 h postoperatively. FCCEB caused less respiratory depression and sensorimotor block, but had less analgesic efficacy than UCISBs (P < 0.05). FCCEB caused nausea, vomiting, and dizziness more frequently (P < 0.05) and had lower patient satisfaction than UCISBs (P < 0.05). UCISB75 can cause severe respiratory distress in patients with lung disorders. Other variables were not significantly different between the groups. UCISB20 may provide superior postoperative analgesia and is the most recommendable postoperative analgesic method in ARCR. Randomized controlled trials, Therapeutic study, Level I.