Jacques T YaDeau1, Michael A Gordon2, Enrique A Goytizolo2, Yi Lin2, Kara G Fields3, Amanda K Goon2, Guilherme Holck2, Timothy W Miu2, Lawrence V Gulotta2, David M Dines2, Edward V Craig3. 1. Departments of *Anesthesiology, and Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA; yadeauj@hss.edu. 2. Departments of *Anesthesiology, and Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA; 3. Departments of *Anesthesiology, and Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA; Healthcare Research Institute, Hospital for Special Surgery, New York, New York, USA;
Abstract
OBJECTIVE: This study investigated interscalene block for shoulder arthroplasty with various ropivacaine concentrations in the presence of clonidine, dexamethasone, and buprenorphine. The goal was prolonged analgesia with minimal motor blockade. DESIGN: Prospective, double-blind, randomized controlled trial. SETTING: University-affiliated orthopedic hospital. METHODS: Patients (20/group) received acetaminophen, ketorolac, pregabalin, opioids, and "Control"; interscalene block, 0.375% ropivacaine, intravenous additives (buprenorphine, clonidine, dexamethasone); "High Dose"; 0.375% ropivacaine, perineural additives; "Medium Dose"; 0.2% ropivacaine, perineural additives; and "Low Dose"; 0.1% ropivacaine, perineural additives. RESULTS:Pain with movement at 24 hours was 4.9 ± 2.5 (mean ±standard deviation [SD]) (Control), 4.5 ± 3.0 (High Dose), 3.4 ± 1.8 (Medium Dose), 4.2 ± 2.4 (Low Dose). The difference between Medium Dose and Control was -1.5 (95% CI: -2.9, -0.1) (P = 0.040). Median time until need for opioids was 16.1 hours (Control) vs 23.7 hours (High Dose); hazard ratio 0.37 [95% CI: 0.17, 0.79]. High Dose had less pain with movement the morning after surgery, vs Control; 2.9 ± 2.5 vs 4.9 ± 2.7; P = 0.027. Pain with movement in the Post-Anesthesia Care Unit was higher in Low Dose, vs Control; 0.9 ± 1.4 vs 0 ± 0, P = 0.009. Low Dose had superior hand strength in the Post-Anesthesia Care Unit (mean ± SD of pre-operative strength: 44.0 ± 20.3%) compared to Control (27.5 ± 24.5%) (P = 0.031). CONCLUSIONS: For maximum pain reduction, combining perineural additives with ropivacaine 0.375% or 0.2% is suggested. To minimize motor blockade, perineural additives can be combined with ropivacaine, 0.1%.
RCT Entities:
OBJECTIVE: This study investigated interscalene block for shoulder arthroplasty with various ropivacaine concentrations in the presence of clonidine, dexamethasone, and buprenorphine. The goal was prolonged analgesia with minimal motor blockade. DESIGN: Prospective, double-blind, randomized controlled trial. SETTING: University-affiliated orthopedic hospital. METHODS:Patients (20/group) received acetaminophen, ketorolac, pregabalin, opioids, and "Control"; interscalene block, 0.375% ropivacaine, intravenous additives (buprenorphine, clonidine, dexamethasone); "High Dose"; 0.375% ropivacaine, perineural additives; "Medium Dose"; 0.2% ropivacaine, perineural additives; and "Low Dose"; 0.1% ropivacaine, perineural additives. RESULTS:Pain with movement at 24 hours was 4.9 ± 2.5 (mean ± standard deviation [SD]) (Control), 4.5 ± 3.0 (High Dose), 3.4 ± 1.8 (Medium Dose), 4.2 ± 2.4 (Low Dose). The difference between Medium Dose and Control was -1.5 (95% CI: -2.9, -0.1) (P = 0.040). Median time until need for opioids was 16.1 hours (Control) vs 23.7 hours (High Dose); hazard ratio 0.37 [95% CI: 0.17, 0.79]. High Dose had less pain with movement the morning after surgery, vs Control; 2.9 ± 2.5 vs 4.9 ± 2.7; P = 0.027. Pain with movement in the Post-Anesthesia Care Unit was higher in Low Dose, vs Control; 0.9 ± 1.4 vs 0 ± 0, P = 0.009. Low Dose had superior hand strength in the Post-Anesthesia Care Unit (mean ± SD of pre-operative strength: 44.0 ± 20.3%) compared to Control (27.5 ± 24.5%) (P = 0.031). CONCLUSIONS: For maximum pain reduction, combining perineural additives with ropivacaine 0.375% or 0.2% is suggested. To minimize motor blockade, perineural additives can be combined with ropivacaine, 0.1%.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Simon J Parrington; Dermot O'Donnell; Vincent W S Chan; Danielle Brown-Shreves; Rajeev Subramanyam; Melody Qu; Richard Brull Journal: Reg Anesth Pain Med Date: 2010 Sep-Oct Impact factor: 6.288
Authors: Admir Hadzic; Brian A Williams; Pelin Emine Karaca; Paul Hobeika; George Unis; Jeffrey Dermksian; Marina Yufa; Daniel M Thys; Alan C Santos Journal: Anesthesiology Date: 2005-05 Impact factor: 7.892
Authors: Jacques T Yadeau; Spencer S Liu; Matthew C Rade; Dorothy Marcello; Gregory A Liguori Journal: Anesth Analg Date: 2011-04-27 Impact factor: 5.108
Authors: M Desmet; H Braems; M Reynvoet; S Plasschaert; J Van Cauwelaert; H Pottel; S Carlier; C Missant; M Van de Velde Journal: Br J Anaesth Date: 2013-04-15 Impact factor: 9.166
Authors: Jacques T YaDeau; Ellen M Soffin; Audrey Tseng; Haoyan Zhong; David M Dines; Joshua S Dines; Michael A Gordon; Bradley H Lee; Kanupriya Kumar; Richard L Kahn; Meghan A Kirksey; Aaron A Schweitzer; Lawrence V Gulotta Journal: Clin Orthop Relat Res Date: 2021-08-01 Impact factor: 4.755
Authors: Rienk van Beek; Harry J Zonneveldt; Tjeerd van der Ploeg; Jeroen Steens; Phillip Lirk; Marcus W Hollmann Journal: Medicine (Baltimore) Date: 2017-07 Impact factor: 1.889