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.
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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
240
Patient will be given a continuous infusion of local anesthetic.
Patient will be given a scheduled intermittent bolus of local anesthetic.
Stanford University
Stanford, California, United States
RECRUITINGPost-surgical pain
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.
Time frame: Post-operative day 0, 1, and 2
Opioid consumption
The amount of opioid analgesics (converted to total morphine milligram equivalents) taken by patients will be recorded.
Time frame: Post-operative day 0, 1, and 2
Local anesthetic use
The amount of supplemental local anesthetic boluses self-administered by patients will be recorded (in mL).
Time frame: Post-operative day 1 and 2
Quality of recovery
Quality of recovery will be assessed using a Quality of Recovery (QoR-15) questionnaire. The QoR15 scores range from 0 to 150, where 0 is poor recovery and 150 is excellent recovery.
Time frame: Post-operative day 1 and 2
Evidence of diaphragmatic paralysis
Ability to breathe will be assessed as a part of QoR-15 questionnaire on 11-point scale, where 0 is never being able to breathe easily and 10 is always being able to breathe easily.
Time frame: Post-operative day 1 and 2
Patient satisfaction
Patients will be asked to assess their satisfaction with pain management (Yes/No).
Time frame: Post-operative day 1 and 2
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