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Early experience with continuous cervical paravertebral block using a stimulating catheter.

Abstract：

BACKGROUND AND OBJECTIVES:This study reports our early experience with continuous cervical paravertebral block (CCPVB) using a stimulating catheter for the management of acute pain after shoulder surgery. METHODS:This prospective observational study presents 256 CCPVB for pain relief after 14 different shoulder operations. Surgery was performed under general anesthesia and blocks were placed prior to induction of general anesthesia (n = 81 [32%]), after induction of general anesthesia (n = 116 [45%]), or postoperatively in the recovery room (n = 59 [23%]). A bolus dose of 30 mL of 0.5% ropivacaine was followed by an infusion of 0.1 mL/kg/h of 0.2% ropivacaine. Patient- or nurse-initiated bolus doses of 10 mL of the same drug were used for breakthrough pain and rescue analgesics were available. Postoperative pain, patient satisfaction, and motor function in different parts of the upper limb were evaluated immediately after surgery (time 0), and then 6, 12, 24, 48, 60 hours, and 14 days postoperatively. RESULTS:An average of 2 (range 1-7) attempts were needed to advance the catheter while still stimulating the nerve. Average postoperative pain ranged from 0.27 +/- 1.04 cm to 0.78 +/- 1.56 cm (mean +/- SD) on a visual analog scale (VAS) (0-10 cm) for the first 48 hours and 3.8 +/- 2.1 cm and 3.5 +/- 2.4 cm at 60 hours and 14 days, respectively. Patient satisfaction on a VAS of 0 to 5 was 4.19 +/- 1.1, 4.28 +/- 1.01, and 4.69 +/- 1.05 at times 0, 6 hours, and 14 days, respectively. Motor function returned to normal in the fingers within 24 hours and in the shoulder within 60 hours. Complications included Horner's syndrome (40%), dyspnea (8%), superficial skin infection (5%), posterior neck pain (22%), subclavian artery puncture (1%), contralateral epidural spread (4%), and 8% of the patients complained of an unpleasant "dead feeling" of the arm. Ninety-one percent of patients would request CCPVB again for future shoulder surgery. There was no evidence of nerve damage.

journal_name

Reg Anesth Pain Med

journal_title

Regional anesthesia and pain medicine

authors

Boezaart AP,De Beer JF,Nell ML

doi

10.1016/s1098-7339(03)00221-9

subject

Has Abstract

pub_date

2003-09-01 00:00:00

pages

406-13

issue

eissn

1098-7339

issn

1532-8651

pii

S1098733903002219

journal_volume

pub_type

临床试验,杂志文章

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Early experience with continuous cervical paravertebral block using a stimulating catheter.