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Category: Volume 06 Issue 05 May 2018
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Title: Interscalene Brachial Plexus Block with Continues Catheter Insertion System and a Disposable Infusion Pump in Patients Undergoing Surgery for Fracture Head of Humerus by open Reduction and Internal Fixation

Authors: Dr Sudhir Patil, Dr Abhijeet Birnale, Dr Suresh Patil, Dr Pradeep Patil

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i5.37

Abstract

Introduction: Interscalene brachial plexus block with continues catheter insertion system and a disposable infusion pump is a commonly employed technique for upper limb surgeries. Postoperatively these patients may be managed by various methods like rescue opioids depending upon VAS score, patient controlled analgesia or a combination of these two. Interscalene brachial plexus block with a continuous catheter insertion system and a disposable infusion pump through which local anesthetic drug is infused perineurally is an effective alternative for providing postoperative analgesia in patients who have undergone various upper limb surgeries. We conducted this comparative study to find out the efficacy of Interscalene brachial plexus block with a continuous catheter insertion system and a disposable infusion pump in providing postoperative analgesia in patients who have undergone open reduction and internal fixation for fracture head of humerus.

Aims and Objectives: To study the efficacy of Interscalene brachial plexus block with a continuous catheter insertion system and a disposable infusion pump in providing postoperative analgesia in patients who have undergone open reduction and internal fixation for fracture head of humerus.

Materials and Methods: This was a comparative study in which total 30 patients who have undergone open reduction and internal fixation for fracture head of humerus were included depending upon inclusion and exclusion criteria. All the patients were operated under interscalene block using 30 ml of 0.5% Ropivacaine. Patients were divided into 2 groups. Group R received 0.2% ropivacaine infusion while Group S received Normal saline infusion for 24 hours postoperatively through continuous catheter insertion system and a disposable infusion pump. Demographic details, duration of surgery, postoperative VAS score and requirement of rescue analgesics were compared in both the groups. 

Results:  Mean age and mean duration of surgery were found to be comparable in both the groups and there was no statistically significant difference between these 2 groups. Hemodynamic parameters were also found to be comparable for initial 24 hours of postoperative period. Patients in group R (Ropivacaine Group) had significantly less requirement of rescue analgesic doses in postoperative period. Moreover mean VAS scores were found to be significantly low in Group R. 

Conclusion: Interscalene brachial plexus block with continues catheter insertion system and a disposable Infusion Pump was found to be an effective method for providing postoperative analgesia to patients undergoing upper limb surgeries.

Keywords: Interscalene brachial plexus block, continues catheter insertion system, Ropivacaine.

References

  1. Monica J, Vredenburgh Z, Korsh J, Gatt C. Acute Shoulder Injuries in Adults. Am Fam Physician. 2016 Jul 15;94(2):119-27.
  2. Berkes MB, Little MTM, Lorich DG. Open reduction internal fixation of proximal humerus fractures. Current Reviews in Musculoskeletal Medicine. 2013;6(1):47-56. 
  3. Kean J, Wigderowitz CA, Coventry DM. Continuous interscalene infusion and single injection using levobupivacaine for analgesia after surgery of the shoulder. A double-blind, randomised controlled trial. J Bone Joint Surg Br. 2006 Sep;88(9):1173-7.
  4. Rosero EB, Joshi GP. Nationwide incidence of serious complications of epidural analgesia in the United States. Acta Anaesthesiol Scand. 2016 Jul;60(6):810-20.
  5. Bajaj P. Continuous perineural catheters for postoperative analgesia: An update. Indian J Anaesth 2007;51:247-9
  6. Byeon GJ, Shin SW, Yoon JU, Kim EJ, Baek SH, Ri HS. Infusion Methods for Continuous Interscalene Brachial Plexus Block for Postoperative Pain Control after Arthroscopic Rotator Cuff Repair. The Korean Journal of Pain. 2015;28(3):210- 216.
  7. Borgeat A, Ekatodramis G, Kalberer F, Benz C. Acute and nonacute complications associated with interscalene block and shoulder surgery: a prospective study. Anesthesiology 2001;95:875-80.
  8. Vester-Andersen T, Christiansen C, Hansen A, et al. Interscalene brachial plexus block: area of analgesia, complications and blood concentrations of local anesthetics. Acta Anaesthesiol Scand 1981;25:81-4.
  9. Patak LS, Tait AR, Mirafzali L, Morris M, Dasgupta S, Brummett CM. Patient Perspectives of Patient-Controlled Analgesia (PCA) and Methods for Improving Pain Control and Patient Satisfaction. Regional anesthesia and pain medicine. 2013;38(4):326-333. 
  10. van Beers EJ, van Tuijn CF, Nieuwkerk PT, Friederich PW, Vranken JH, Biemond Patient-controlled analgesia versus continuous infusion of morphine during vaso-occlusive crisis in sickle cell disease, a randomized controlled trial. Am J Hematol. 2007 Nov;82(11):955-60.
  11. Klein SM, Grant SA, Greengrass RA, Nielsen KC, Speer KP, White W, Warner DS, Steele SM. Interscalene brachial plexus block with a continuous catheterinsertion system and a disposable infusion pump. Anesth Analg. 2000 Dec;91(6):1473-8.
  12. Ilfeld BM, Morey TE, Wright TW, Chidgey LK, Enneking FK. Continuous interscalene brachial plexus block for postoperative pain control at home: a randomized, double-blinded, placebo-controlled study. Anesth Analg. 2003 Apr;96(4):1089-95.
  13. Mariano ER, Afra R, Loland VJ, Sandhu NS, Bellars RH, Bishop ML, Cheng GS, Choy LP, Maldonado RC, Ilfeld BM. Continuous interscalene brachial plexus block via an ultrasound-guided posterior approach: a randomized, triple-masked, placebo-controlled study. Anesth Analg. 2009 May;108(5):1688-94.
  14. Bertoglio S, Fabiani F, Negri PD, Corcione A, Merlo DF, Cafiero F, Esposito C, Belluco C, Pertile D, Amodio R, Mannucci M, Fontana V, Cicco MD, Zappi L. The postoperative analgesic efficacy of preperitoneal continuous wound infusion compared to epidural continuous infusion with local anesthetics after colorectal cancer surgery: a randomized controlled multicenter study. Anesth Analg. 2012 Dec;115(6):1442-50.
  15. Yang CW, Jung SM, Kwon HU, et al. A clinical comparison of continuous interscalene brachial plexus block with different basal infusion rates of 0.2% ropivacaine for shoulder surgery. Korean Journal of Anesthesiology. 2010;59(1):27-33. 

Corresponding Author

Dr Sudhir Patil

Senior Consultant Anesthetist, PIOS Multispecialty Hospital, Jaysingpur- Sangli- Maharashtra, India