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

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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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Data sharing: original, de-identified, data are available upon request.

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Acknowledgements

Assistance with the study: Mrs. Annick Leroy for reviewing the statistical analysis. This manuscript has been edited by American Journal Experts.

Funding

Financial support and sponsorship: resources were provided from the Department of Anesthesiology only.

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Authors and Affiliations

  1. Department of Anesthesiology, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium

    Luc A. Sermeus, Tom Schepens, Stuart G. Morrison, Margaretha B. Breebaart, Carine J. Smitz & Marcel P. Vercauteren

  2. Department of Algology and Evidence Based Medicine, Multidisciplinary Pain Center, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium

    Guy H. Hans

  3. Department of Scientific Coordination and Biostatistics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium

    Kristien Wouters

Authors
  1. Luc A. Sermeus
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  2. Tom Schepens
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  7. Carine J. Smitz
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  8. Marcel P. Vercauteren
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Contributions

LS conceived the study, participated in its design and coordination, performed the blocks, analyzed the QST results and wrote the manuscript. GH helped conceive the study design, performed the QST interpretation, helped in the analysis of the data, assisted in manuscript drafting and edited the various versions of the manuscript. TS helped in the analysis of the data, assisted in writing and reviewed the manuscript. SM assisted in writing and reviewing the manuscript. KW performed the statistical analysis. MB helped conceive the study design and performed a critical reading. CS performed QST testing and collected data. MV critically read the various versions of the manuscript.

Corresponding author

Correspondence to Luc A. Sermeus.

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Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Additional file 1

: All mixed model values of nerve blockage effects over time, per dermatome and per study group. Statistical methodology and P-values of the within/between-subject effects in the censored mixed effects model. (DOCX 73 KB)

Additional file 2

: Graphics of all neurosensitive/nociceptive responses. Time course of the neurosensory changes in detection thresholds for all sensations, Cold &#x0026; Warm Sensation and Cold &#x0026; Heat Pain (Temperature in °C) in the different dermatomes (C4, C5, C6, C7) for the 3 anesthetic solutions (0.5%Bup, 0.5%BupEpi, 0.75%Rop) measured with quantitative sensory testing (mean, standard deviation). The increases in thresholds are significant as compared to pre-injection thresholds. Detection thresholds between the 3 local anesthetics did not differ significantly. (DOCX 436 KB)

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Sermeus, L.A., Schepens, T., Hans, G.H. et al. A low dose of three local anesthetic solutions for interscalene blockade tested by thermal quantitative sensory testing: a randomized controlled trial. J Clin Monit Comput 33, 307–316 (2019). https://doi.org/10.1007/s10877-018-0150-3

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  • DOI: https://doi.org/10.1007/s10877-018-0150-3

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