Interscalene brachial plexus block with a continuous catheter insertion system and a disposable infusion pump

Continuous interscalene brachial plexus blockade traditionally requires a h ospital stay for local anesthetic infusion, and achieving consistent cathet er insertion may be difficult. Incorporating long-acting pain relief from a continuous peripheral nerve block, with a reliable method of catheter inse rtion, and a self-contained infusion system would be a valuable asset for s hort-stay care. We compared the efficacy of single injection interscalene b rachial plexus blockade to a continuous peripheral nerve block, with an ins ulated Tuohy system and a disposable infusion pump. Forty adult patients sc heduled for open rotator cuff repair were entered in this randomized, doubl e-blinded, placebo-controlled study. Patients received an interscalene brac hial plexus blockade and a continuous peripheral nerve catheter as their pr imary anesthetic and then, were assigned to receive one of two different po stoperative infusions: either 0.2% ropivacaine at 10 mL/h via a disposable infusion pump or normal saline at 10 mL/h via a disposable infusion pump (n = 18-20 per group). Visual analog pain scores and postoperative morphine c onsumption were measured for 24 h. The ropivacaine group showed less pain t han the placebo group (P = 0.0001) between 12 and 24 h after the initial in jection of local anesthetic. In addition, initial interscalene blockade was successful in all patients and all redosed catheters were functional after 24 h with the continuous catheter insertion system. We conclude that it is possible to achieve a high rate of successful catheter placement and analg esia by using the continuous catheter insertion system and a disposable inf usion pump in the ambulatory setting. This method of analgesia may offer im proved pain relief after outpatient rotator cuff repair.