Ultrasound-Guided Interscalene Brachial Plexus Block: Single Bolus Injection versus Continuous Catheter Placement in Arthroscopic Rotator Cuff Repair with Implications for Postoperative Rehabilitation - A Prospective Randomized Unblinded Trial.

Abstract

Purpose: This study examined the effectiveness of the interscalene brachial plexus single-shot block (ISBSS) versus continuous block (ISBC) in managing acute and chronic postsurgical pain (PSP) in patients undergoing upper extremity surgery, and differences between the two groups in rehabilitation.

Patients and methods: Patients who underwent shoulder arthroscopy under locoregional anesthesia received either single-shot (ISBSS group) (n = 42) or continuous perineural catheter (ISBC group) anesthesia (n = 38). The primary outcome was the numeric rating scale (NRS) score related to PSP evaluation. Secondary outcomes included the American Shoulder and Elbow Surgeons Score (ASES), range of motion (ROM) in degrees, hospital length of stay, and opioid consumption, all measured postoperatively and during the rehabilitation evaluation.

Results: ISBC group exhibited lower median [interquartile range, IQR] NRS score than ISBSS group at postoperative hour 20 (2 [2 to 3] vs 4 [2 to 5]), 24 (2 [2 to 2] vs 4 [1 to 5]), 48 (1 [1 to 2] vs 4 [4 to 5]), 72 (1.5 [1 to 2] vs 5 [4 to 5]) (P < 0.001, resp.); at postoperative day 7 (1 [1 to 2] vs 5 [5 to 6], P < 0.001) and postoperative month 1 (1 [1 to 1] vs 3 [3 to 3], P < 0.001). The ISBC group demonstrated lower opioid consumption, a better ASES score, and higher ROM grades at follow-up month 3 for flexion, abduction, and internal and external rotation (P < 0.001).

Conclusion: Continuous interscalene brachial plexus catheter infusion may effectively control acute and chronic PSP, facilitating better rehabilitation and healing than single shot injection.