A Prospective Comparison of Pain and Analgesia in Patients With Continuous Peripheral Nerve Block Catheters Using Continuous Infusion or Scheduled Bolus Infusion
Overview
- Phase
- Phase 4
- Intervention
- Ropivacaine
- Conditions
- Surgical Procedure, Unspecified
- Sponsor
- Stanford University
- Enrollment
- 240
- Locations
- 1
- Primary Endpoint
- Post-surgical pain
- Status
- Recruiting
- Last Updated
- 4 months ago
Overview
Brief Summary
The goal of the study is to compare continuous infusions and scheduled bolus infusions for peripheral nerve blocks and their effect on post-surgical pain.
Detailed Description
Regional anesthetic techniques are an integral part to many anesthetic approaches, providing both intraoperative and postoperative anesthesia and analgesia. Regional anesthesia peripheral nerve blocks have been shown to reduce postoperative pain and improve measures such as opioid requirements and readiness for discharge. By using a catheter technique for continuous peripheral nerve blocks, analgesia can be extended well into post-operative days 2 and 3, further extending these benefits. Historically these catheters have implemented a continuous dosing regimen of local anesthetic, but increasingly there is evidence of improved analgesic outcomes without adverse effects by using a scheduled bolus dosing regimen. Many institutions have implemented this new protocol for catheter dosing. The beneficial effect of scheduled bolus dosing has not been studied in all blocks and all surgical procedures. The study will consist of three independent arms, each designed to evaluate a different nerve block site: interscalene, adductor canal, and infraclavicular. A total of 60 patients will be enrolled in each arm.
Investigators
Jean-Louis Horn
Professor of Anesthesiology
Stanford University
Eligibility Criteria
Inclusion Criteria
- •Adult patients presenting for nerve block catheters for post-operative analgesia
- •ASA physical status I, II, or III.
Exclusion Criteria
- •Pregnancy
- •Incarceration
- •Pre-operative opioid use \>30 mg morphine equivalents per day
- •Inability to communicate with investigators by telephone
- •Pre-existing neuropathy of the operative extremity.
Arms & Interventions
Continuous Infusion
Local anesthetic medication (Ropivacaine 0.2%) is provided at a continuous basal rate.
Intervention: Ropivacaine
Intermittent Bolus Infusion
Local anesthetic medication (Ropivacaine 0.2%) is provided in scheduled, intermittent boluses.
Intervention: Ropivacaine
Outcomes
Primary Outcomes
Post-surgical pain
Time Frame: Post-operative day 0, 1, and 2
Pain scores will be collected using a Numeric Rating Scale (NRS) from 0-10, where 0 is the lowest and 10 is the highest pain level.
Secondary Outcomes
- Opioid consumption(Post-operative day 0, 1, and 2)
- Local anesthetic use(Post-operative day 1 and 2)
- Quality of recovery(Post-operative day 1 and 2)
- Evidence of diaphragmatic paralysis(Post-operative day 1 and 2)
- Patient satisfaction(Post-operative day 1 and 2)