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IS POSSIBLE AVOIDING REBOUND PAIN AFTER REGIONAL ANALGESIA? CASE SERIES OF CONTINUOUS AMBULATORY FEMORAL OR INTERSCALENE CATHETER UNDER ULTRASOUND GUIDANCE IN DEVELOPING COUNTRY
ESRA Academy. Rubio J. Sep 8, 2016; 138253; 0072 Topic: Shoulder Surgery
Jorge Rubio
Jorge Rubio

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Abstract
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Background and Aims:

Continuous analgesia has been shown to improve functional recuperation.1, 2-5 Rebound pain is main reason for postoperative emergency visits and unplanned admission. A multimodal analgesia offers benefits in ambulatory setting: pain management, opioids sparing technique, with increase patient comfort and improving postoperative outcomes

Methods:

After IRB approval, 52 patients older than 18 years with ASA PS I to II scheduled for elective arthroscopic shoulder or knee surgery are reported. All patients received preoperative ultrasound-guided block. An elastomeric pump with bupivacaine 0.1 % 5 mL/h, was used during 50 hours. Postoperative analgesia regimen included oral NSAIDs and acetaminophen. After, telephonic follow up were done till 1 year after surgery

Results:

The mean operative time was 189 minutes. In the PACU, VAS was lower than 3/10, only 4 patients required rescue analgesic. No patient had nausea and vomiting. All patients reported high levels of satisfaction with their postoperative care.

Conclusions:

Continuous blocks for shoulder or knee arthroscopies could be an effective strategy for reducing rebound postoperative pain and opioid consumption. The ultrasound guided continuous block in combination with oral NSAIDs and acetaminophen for 5 to 7 days provided excellent pain relief and avoided the use of opioids reducing the risk of side effects such as nausea and vomiting. Trials reviewed suggest early pain control with single shot, lasting 8 hours for static and maximal 6 hours for dynamic pain.2

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