Comparison of Single Dose with Continuous Infusion of 0.2% Ropivacaine in Interscalene Brachial Plexus Nerve Block for Pain Relief in Rotator Cuff Repair Surgery

Abstract

Background: Severe postoperative pain is the most common complication after arthroscopic rotator cuff surgery. Peripheral nerve blocks, whether single-shot interscalene block (SSISB) or continuous interscalene nerve block, have consistently demonstrated superior analgesia after upper extremity surgery compared to general anesthesia alone. Aims: The aim of this study was to evaluate the difference in pain relief provided by single shot versus catheterized interscalene block. Materials and Methods: A prospective observational study was conducted in the Department of Orthopedics of Justice K.S.Hegde Charitable Hospital, Mangalore, from January 2020 to June 2021. Thirty patients who were diagnosed of complete rotator cuff tear were included in the study. All of them underwent arthroscopy-assisted single-row rotator cuff repair by the same surgeon under general anesthesia. They were randomly allocated into Groups I and B of 15 each. Patients in Group A received a SSISB and Group II received continuous infusion after the insertion of catheter. The catheter was removed after 24 h of surgery. Both groups followed the same postoperative management protocol. The pain perception assessment was measured using the Visual Analog Scale (VAS) at 6, 24, 48 h after surgery, and at 2nd week postoperative during suture removal. Power was assessed for the wrist (wrist flexion and extension) and for the fingers (finger flexion and abduction) at 6 h, 24 h, 48 h, and after 2 weeks on day 14 when suture removal was done. The results were calculated and tabulated using an independent “t-test” and “Chi-square test.” Results: The patients in Group A had a higher VAS score with a mean of 0.26 ± 0.06 as compared to Group B which showed a mean VAS score of 0 (P = 0.01). Six patients needed analgesia of postoperative day 2. Eight patients of Group B required rescue analgesia on postoperative day 2. Conclusion: Continuous infusion scalene block was noted to be superior to SSISB in the management of postoperative pain postarthroscopy assisted single-row rotator cuff repair.