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Published in: Journal of Clinical Monitoring and Computing 2/2019

01-04-2019 | Original Research

A low dose of three local anesthetic solutions for interscalene blockade tested by thermal quantitative sensory testing: a randomized controlled trial

Authors: Luc A. Sermeus, Tom Schepens, Guy H. Hans, Stuart G. Morrison, Kristien Wouters, Margaretha B. Breebaart, Carine J. Smitz, Marcel P. Vercauteren

Published in: Journal of Clinical Monitoring and Computing | Issue 2/2019

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Abstract

This randomized double-blind controlled trial compared the block characteristics of three low-dose local anesthetics at different roots in an ultrasound-guided interscalene block, using thermal quantitative sensory testing for assessing the functioning of cutaneous small nerve fibres. A total of 37 adults scheduled to undergo shoulder arthroscopy were randomized to receive 5 mL of either 0.5% levobupivacaine with and without epinephrine 1/200,000 or 0.75% ropivacaine in a single-shot interscalene block. Thermal quantitative sensory testing was performed in the C4, C5, C6 and C7 dermatomes. Detection thresholds for cold/warm sensation and cold/heat pain were measured before and at 30 min, 6, 10 and 24 h after infiltration around C5. The need for rescue medication was recorded. No significant differences between groups were found for any sensation (lowest P = 0.28). At 6 h, the largest differences in sensory thresholds were observed for the C5 dermatome. The increase in thresholds were less in C4 and C6 and minimal in C7 for all sensations. The analgesic effect lasted the longest in C5 (time × location mixed model P < 0.001 for all sensory tests). The time to rescue analgesia was significantly shorter with 0.75% ropivacaine (P = 0.02). The quantitative sensory findings showed no difference in intensity between the local anesthetics tested. A decrease in block intensity, with minimal changes in pain detection thresholds, was observed in the roots adjacent to C5, with the lowest block intensity in C7. A clinically relevant shorter duration was found with 0.75% ropivacaine compared to the other groups. Trial registration NCT 02691442.
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Metadata
Title
A low dose of three local anesthetic solutions for interscalene blockade tested by thermal quantitative sensory testing: a randomized controlled trial
Authors
Luc A. Sermeus
Tom Schepens
Guy H. Hans
Stuart G. Morrison
Kristien Wouters
Margaretha B. Breebaart
Carine J. Smitz
Marcel P. Vercauteren
Publication date
01-04-2019
Publisher
Springer Netherlands
Published in
Journal of Clinical Monitoring and Computing / Issue 2/2019
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI
https://doi.org/10.1007/s10877-018-0150-3

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