EFFECTIVENESS OF 0.2% ROPIVACAINE OR 0.2 % BUPIVACAINE DURING ULTRASOUND GUIDED AMBULATORY INTERSCALENE PLEXUS BLOCK FOR FROZEN SHOULDER MOBILIZATION
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2019, Vol 8, Issue 3
Abstract
BACKGROUND Interscalene Brachial plexus block has been utilized to provide analgesia for shoulder mobilization in frozen shoulder patients, but the associated motor blockade of the upper limb decreases the ability of the patient to do active physiotherapy. Several in-vitro studies have shown that Ropivacaine provided differential blockade with less motor weakness when compared to Bupivacaine. Hence, we designed this study to look at the motor and sensory blockade characteristics of the interscalene brachial plexus block when Ropivacaine or Bupivacaine were used as local anaesthetics. MATERIALS AND METHODS This randomised double blinded study was conducted in Karpagam Faculty of Medical Sciences and Research, Coimbatore, from November 2016 to November 2018. 60 patients who had frozen shoulder and who were planned for mobilization under anaesthesia were recruited. All patients were evaluated completely, and the procedure was done after obtaining informed consent. Under strict aseptic measure, interscalene catheter was introduced under the guidance of ultrasound and 20 ml of unlabelled local anaesthetic solution containing either 0.2% Ropivacaine or 0.2% Bupivacaine were injected. After satisfying discharge criteria, patients were ambulated to the physiotherapy department where blinded physiotherapist mobilized the shoulder joint. The sensory and motor onset time, degree and duration of motor blockade, quality and duration of shoulder analgesia were recorded. RESULTS Both Ropivacaine and Bupivacaine provided satisfactory analgesia (VAS score < 2) in all patients during shoulder mobilization. But the median degree of motor blockade (2 vs 2) and duration of motor blockade (222.4 ± 88.4 vs 239.4 ± 89.8 minutes, P = 0.451) were not less with Ropivacaine when compared to Bupivacaine. Similarly, the duration of analgesia (259.80 ± 82.2 vs 273.00 ± 89.5 minutes, p = 0.554) was comparable between the groups. The sensory onset was one minute earlier in Bupivacaine when compared to Ropivacaine (2.2 ± 1.2 vs 3.2 ± 1.9 minutes, p = 0.017) which was not clinically significant, but the motor onset time was comparable (6.7 ± 3.4 vs 8.3 ± 3.7 minutes, p = 0.081). CONCLUSION We conclude that 0.2% Ropivacaine provided effective analgesia for frozen shoulder mobilization but did not provided favourable sensory motor differential blockade over Bupivacaine 0.2% for frozen shoulder management
Authors and Affiliations
Naveen Chandru Anguchamy, Vijayakumar Natarajan, Kamalakannan Manian
Keywords
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- EP ID EP553117
- DOI 10.14260/jemds/2019/40
- Views 70
- Downloads 0
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