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Friday, March 2, 2001

CIBPB at home produces excellent results

Continuous interscalene brachial plexus blockade (CIBPB) has been successfully used for major shoulder surgery in hospital settings. A pilot clinical study designed to evaluate the efficacy of CIBPB at home found it achieved excellent analgesia levels with low incidence of adverse effects.

According to the study in scientific exhibit 2, four patients scheduled for rotator cuff repair under CIBPB were discharged home with an interscalene catheter connected to an automated infusion pump containing 0.2 percent ropivacaine 10ml/h for 72 hours. Prior to discharge, patients were provided written instructions concerning adverse effects and contact information.

The researchers evaluated pre/post-op pain (verbal analogue scale, 0 = no pain/10 = worst imaginable pain); nausea/vomiting (0 = no nausea/10 = vomiting); cognitive function (Modified MiniMental State questionnaire); sleep (hours/night); shoulder function (Modified American Shoulder and Elbow Society); adverse effects; and patient satisfaction.

The average pain score over three days was 0.64. The mean nausea score was 0.4±1.3. There were no complications due to local anesthetic toxicity or catheter use. Comparing pre-op and mean scores over three post-op days, there was an increase of hours of sleep/night (5-7 hours, p= 0.003) and cognitive function (18.8-21.6 points, p=0.02). Functional score improved from 25±5.6 pre-op to 30.4±9 points at 90 post-op days. No complications were recorded during the 90-day follow-up.

All patients were very satisfied with the overall experience, the researchers said. They recommended that additional studies should focus on the potential cost saving effects associated with this procedure.

The study was conducted by Ricardo Pietrobon, MD; Kevin P. Speer, MD; Karen C. Nielsen, MD; Stephen M. Klein, MD; Roy A. Greengrass, MD; and Susan M. Steele, MD, all of Duke University Medical Center, Durham, N.C.

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2001 Academy News March 2 Index B

Last modified 20/February/2001 by IS