Postoperative Analgesia After Shoulder Replacement

Official Title: “Comparison Of 0.5% Vs. 0.75% Ropivacaine Interscalene Brachial Plexus Block (ISB) Prior To Elective Total Shoulder Replacement Surgery On Use of Analgesic Medication During Post-Discharge Week”

A comparison was made regarding opioid analgesic usage immediately after elective shoulder replacement and for seven days at home between patients randomly given either 0.5% or 0.75% ropivacaine via interscalene block prior to surgery.

It is hypothesized that no significant difference will exist between both groups with respect to pain medication used in the hospital and for a 7-day period at home.

After IRB approval, 46 patients undergoing elective shoulder replacement surgery were recruited at Methodist Hospital (Philadelphia) for this single blind, randomized pilot study. Consented patients spent 48 hours in-house. They were randomly given either 0.5% or 0.75% ropivacaine via interscalene block (ISB) prior to surgery. After the operation, patients were transferred to the post anesthesia care unit (PACU) and placed on a patient controlled analgesia (PCA) morphine pump: basal rate of 0 mg; bolus of 1 mg; lock-out period of 10 min (maximum dose of 6 mg/hr). If the PCA did not provide adequate analgesia, subjects could also receive a bolus of morphine, 2 to 4 mg i.v., every fifteen minutes for several doses p.r.n. In addition, parameters of the PCA could also be modified in order to allow for increased delivery of morphine (e.g., lock-out of 6 min w/max dose of 10 mg/hr) for patient analgesia. PCA morphine therapy was continued after patient was transferred from the PACU to the patient's recovery room. PCA morphine therapy was discontinued the day after surgery and patients were given oral Percocet tablets for pain management. .

Thirty-nine patients successfully completed this part of the study. There was no significant difference (p>0.05) between groups in amount of post-operative medications consumed (PCA morphine and oral analgesics) or post-operative pain.

Upon release, patients were given pain and medication diaries to complete for seven successive days. All patients recorded the total amount of Percocet tablets taken at home each day in addition to pain scores (0-10) in the morning, afternoon and evening.

Twenty-seven patients successfully completed this part of the study. There was no significant difference (p>0.05)between groups in regard to pain; however, patients in the higher 0.75% group unexpectedly took more tablets (p<0.05).

Conclusion: The 0.5% ISB dose of ropivacaine was found to be equally efficacious as 0.75%; since this lower concentration would also reduce the risk of serious systemic toxicity, it is recommended for ISB prior to elective shoulder replacement.

Arms, Groups and Cohorts in this Clinical Trial

• : 0.5% Ropivicaine (150 mg)
• : 0.75% Ropivicaine (225 mg)

Primary Measures

• Amount of PCA morphine used by pt
  • Time Frame: for 24 hours following surgery
    Safety Issue?: No

Secondary Measures

• Amt of analgesic medication used daily at home for 7 days after discharge from hospital
  • Time Frame: recorded for 7 days at home following discharge from hospital
    Safety Issue?: No

Inclusion Criteria:

• patients undergoing total shoulder replacement surgery
• 18 years of age or older
• expected length of stay of at least 24 hours
• able to report pain levels
• able to request medications as needed
• American Society of Anesthesiologist (ASA) physical status classification of P1 or P2

Exclusion Criteria:

• liver disease
• kidney disease
• antidepressant therapy (e.g., for clinical depression and/ or chronic pain syndrome)
• ASA physical status classification of P3 or higher
• pregnancy
• allergy to any medications used to treat patient

Gender Eligibility for this Clinical Trial: Both

Minimum Age for this Clinical Trial: 18 Years

Maximum Age for this Clinical Trial: N/A

Are Healthy Volunteers Accepted for this Clinical Trial?: Accepts Healthy Volunteers

Lead Investigator: Thomas Jefferson University Other

Overall Clinical Trial Officials and Contacts

Dean Steinberg, MD Principal Investigator Thomas Jefferson University  

Information obtained from ClinicalTrials.gov on February 09, 2012

Link to the current ClinicalTrials.gov record. http://clinicaltrials.gov/show/NCT01003860

Study ID Number: PCOM2009-01

ClinicalTrials.gov Identifier: NCT01003860

Health Authority: United States: Federal Government