Comparing the Effects of Infusion and Bolus Doses of Bupivacaine Applied with Infraclavicular Catheter on the Duration and Need of Postoperative Analgesia

Abstract

Objective: This study aimed to evaluate postoperative analgesia duration, analgesic requirements, and patient satisfaction between continuous infusion and bolus injection techniques using an infraclavicular catheter in patients undergoing forearm surgery. Material and Method: We examined 100 patients which were divided into 2 groups to evaluate the data retrospectively. Bolus Injection Group (B): Patients who received 4 mL of bupivacaine (0.5%) from the catheter if the VAS value was > 3. Continuous Infusion Group (C): Patients who received 20 mg bupivacaine (0.02%) infusion via catheter using an infusion pump in 24 hours. Demographic data, American Society of Anesthesiologists (ASA) score, intraoperative and postoperative hemodynamic data, sensory and motor block onset times, postoperative Visual Analogue Scale (VAS) (1-2-6-12-24th hour), postoperative 24th and 48th hour satisfaction score, obtained from anesthesia and algology follow-up forms, were evaluated. Results: When both groups were compared, VAS6 and VAS24 values of Group C were found to be statistically significantly lower than Group B. Satisfaction scores revealed that significantly more patients in Group C reported being very satisfied compared to Group B. Conclusion: Our findings suggest that continuous local anesthetic infusion via catheter offers more sustainable analgesia compared to bolus administration.

Keywords

• Plexus Blockade
• Brachial
• Catheterization
• Peripheral
• Analgesia

Supporting Institution

This research was supported by the Scientific Research Projects management unit of Suleyman Demirel University with the project number 4745-TU2-16.

Project Number

4745-TU2-16.

Ethical Statement

Suleyman Demirel University Faculty of Medicine Clinical Research Ethics Committee, (Date: 31.05.2017, protocol no: 113). This study was conducted in line with the principles of the "Helsinki Declaration".

Thanks

We are grateful to Suleyman Demirel University Scientific Research Project Unit for their great support (project number: 4745-TU2-16) in the conduct of the study.

References

1. 1. Dolin SJ, Cashman JN. Tolerability of acute postoperative pain management: nausea, vomiting, sedation, pruritis, and urinary retention. Evidence from published data. Br J Anaesth 2005;95(5):584-91.
2. 2. Langman MJ, Weil J, Wainwright P, Lawson DH, Rawlins MD, et al. Risk of bleeding peptic ulcer associated with individual non-steroidal anti-inflammatory drugs. Lancet 1994;343:1075-8.
3. 3. Mukherjee D, Nissen SE, Topol EJ. Risk of cardiovascular events associated with selective COX-2 inhibitors. JAMA 2001;286:954-9.
4. 4. Rodríguez J, Taboada-Muñiz M, Bárcena M, Alvarez J. Median versus musculocutaneous nerve response with single-injection infraclavicular coracoid block. Reg Anesth Pain Med 2004;29:534-538.
5. 5. Arcand G, Williams SR, Chouinard P, Boudreault D, Harris P, et al. Ultrasound-guided infraclavicular versus supraclavicular block. Anesth Analg 2005;101:886-890.
6. 6. Marhofer P, Schrogendorfer K, Wallner T, Koi-nig H, Mayer N, et al. Ultrasonographic guidance reduces the amount of local anesthetic for 3-in-1 blocks. Reg Anesth Pain Med 1998;23:584-588.
7. 7. Roy M, Ramdoyal N, Meouchy M, Garneau S, Robin FA. retrospective evaluation of the failure rate of continuous infraclavicular nerve blockade in the ambulatory setting. Can J Anaesth 2021;68(8):1281-1282.
8. 8. Lee JH, Kim H, Kim JK, Cheon S, Shin YH. Does intravenous patient-controlled analgesia or continuous block prevent rebound pain following infraclavicular brachial plexus block after distal radius fracture fixation? A prospective randomized controlled trial. Korean J Anesthesiol 2023;76(6):559-566.

9. 9. Kamel I Ahmed MF, Sethi A. Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know. World J Orthop 2022;18;13(1):11-35.
10. 10. Ganta A, Ding D, Fisher N, Lavery J, Jain S, Tejwani NC. Continuous infraclavicular brachial block versus single-shot nerve block for distal radius surgery: A prospective randomized control trial. J Orthop Trauma 2018;32(1):22-26.
11. 11. Klein SM, Grant SA, Greengrass RA, Nielsen KC, Speer KP, et al. Interscalene brachial plexus block with a continuous catheter insertion system and a disposable infusion pump. Anesth Analg 2000;91:1473–8.
12. 12. Ilfeld BM, Morey TE, Enneking FK. Continuous infraclavicular brachial plexus block for postoperative pain control at home. Anesthesiology 2002;96:1297–1304.
13. 13. Gürkan Y, Hoşten T, Tekin M, Acar S, Solak M, et al. Comparison of ultrasound-guided supraclavicular and infraclavicular approaches for brachial plexus blockade. Ağrı 2012;24(4):159-164.
14. 14. Koscielniak-Nielsen ZJ, Frederiksen BS, Rasmussen H, Hesselbjerg L. A comparison of ultrasound-guided supraclavicular and infraclavicular blocks for upper extremity surgery. Acta Anaesthesiol Scand 2009;53(5):620-6.
15. 15. Sandhu NS, Capan LM. Ultrasound-guided infraclavicular brachial plexus block. Br J Anaesth 2002;89(2):254-9.
16. 16. Sauter AR, Dodgson MS, Stubhaug A, Halstensen AM, Klaastad Q. Electrical nerve stimulation or ultrasound guidance for lateral sagittal infraclavicular blocks: a randomized, controlled, observer-blinded, comparative study. Anesth Analg 2008;106(6):1910-5.
17. 17. Ilfeld BM, Le LT, Ramjohn J, Loland VJ, Wadhwa AN, et al. The effects of local anesthetic concentration and dose on continuous infraclavicular nerve blocks: A multicenter, randomized, observer-masked, controlled study. Anesth Analg 2009;108(1):345-50.
18. 18. Ilfeld BM, Morey TE, Enneking FK. Infraclavicular perineural local anesthetic infusion: a comparison of three dosing regimens for postoperative analgesia. Anesthesiology 2004;100(2):395-402.
19. 19. Chelly JE, Ghisi D, Fanelli A. Continuous peripheral nerve blocks in acute pain management. Br J Anaesth 2010;105 (1):86-96.
20. 20. Ilfeld BM. Continuous peripheral nerve blocks: a review of the published evidence. Anesth Analg 2011;113(4):904-25.
21. 21. Paul JE, Arya A, Hurlburt L, Cheng J, Thabane L, et al. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: A meta-analysis of randomized controlled trials. Anesthesiology 2010;113(5):1144-62.
22. 22. Kandasami M, Kinninmonth AW, Sarungi M, Baines J, Scott NB. Femoral nerve block for total knee replacement - a word of caution. Knee 2009;16(2):98-100.
23. 23. Memtsoudis SG, Danninger T, Rasul R, Poeran J, Gerner P, et al. Inpatient falls after total knee arthroplasty: the role of anesthesia type and peripheral nerve blocks. Anesthesiology 2014;120(3):551-63.
24. 24. Liu Q, Chelly JE, Williams JP, Gold MS. Impact of peripheral nerve block with low dose local anesthetics on analgesia and functional outcomes following total knee arthroplasty: A retrospective study. Pain Med 2015;16(5):998-1006.