Search

Purpose Ultrasound (US)-guided continuous interscalene brachial plexus block (CBPB) is known to provide effective pain relief for arthroscopic rotator cuff repair. This study was conducted to compare analgesic efficacy and forearm muscle tone of the basal infusion rate and bolus dose of 0.2% ropivacaine for US-guided CBPB with intravenous patient-controlled analgesia (IV-PCA). Methods In a prospective trial, 99 patients scheduled to undergo arthroscopic rotator cuff repair were divided into three groups. In groups A and B, an US-guided 17-gauge Tuohy needle was inserted into the interscalene brachial plexus. A loading dose of 10 ml 0.2% ropivacaine was administered via the needle. A 19-gauge perineural catheter was then inserted through the needle and advanced to a depth of 1.5 cm beyond the needle tip between the C5 and C6 nerve trunks. After surgery, groups A and B received a continuous infusion of 0.2% ropivacaine at 4 or 0 ml/h, a bolus of 0 or 4 ml, and a lockout time of 60 min through the catheter, respectively. Group C received IV-PCA. Pain scores and the forearm muscle tone of patients were compared using a numeric rating scale (NRS), rates of patients taking supplementary opioid analgesics, and manual muscle test (MMT) scoring. Results The NRS scores and rate of patients taking supplementary opioid analgesics in groups A and B were lower than those in group C after surgery. Groups A and B showed similar clinical efficacy. There were no significant differences in MMT scoring among the three groups. Conclusions The bolus dose of 0.2% ropivacaine using US-guided CBPB would provide equivalent analgesic efficacy comparable with the basal infusion and motor weakness comparable with IV-PCA after arthroscopic rotator cuff repair. Keywords Arthroscopic surgery * Muscle relaxation * Nerve block * Patient-controlled analgesia * Rotator cuff * Ultrasonography, Introduction Although arthroscopic rotator cuff repair has the advantages of decreased scarring, faster recovery owing to decreased overall pain and infection, and a shorter admission period than open shoulder surgery, [...]

Purpose Chemical denervation is not recommended as part of the routine care of chronic non-cancer pain. Physicians face a dilemma when it comes to repeated interventions in cases of recurrent thoracolumbar facet joint pain after successful thermal radiofrequency ablation (RFA) in medial branch neurotomy. This study was performed to compare the effects of alcohol ablation (AA) with thermal RFA in patients with recurrent thoracolumbar facet joint pain after thermal RFA treatment. Methods Forty patients with recurrent thoracolumbar facet joint pain after successful thermal RFA defined as a numeric rating scale (NRS) score of ≥ 7 or a revised Oswestry disability index (ODI) of ≥ 22 % were randomly allocated to two groups receiving either the same repeated RFA (n = 20) or AA (n = 20). The recurrence rate was assessed with NRS and ODI during the next 24 months, and adverse events in each group were recorded. Results During the 24-month follow-up after RFA and AA, one and 17 patients, respectively, were without recurring thoracolumbar facet joint pain. The median effective periods in the RFA and AA groups were 10.7 (range 5.4-24) and 24 (range 16.8-24) months, respectively (p < 0.000). No significant complications were observed with the exception of injection site pain, which occurred in both groups. Conclusion In our patient cohort, alcohol ablation in medial branch neurotomy provided a longer period of pain relief and better quality of life than repeated radiofrequency medial branch neurotomy in the treatment of recurrent thoracolumbar facet joint pain syndrome after successful thermal RFA without significant complications during the 24-month follow-up. Keywords Ablation technique * Ethyl alcohol * Facet joint * Radiofrequency catheter ablation * Recurrence, Introduction Radiofrequency ablation (RFA) in facet joint pain syndrome is currently preferred over other modalities due to its precision, reproducibility, and effectiveness. This technique also has the advantage that it [...]