{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T21:10:49Z","timestamp":1789593049051,"version":"build-2803163510"},"reference-count":15,"publisher":"BMJ","issue":"5","funder":[{"name":"European Society of Regional Anesthesia and Pain Therapy","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"Department of Anesthesia, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2023,7,25]]},"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Previous trials favored a continuous interscalene brachial plexus block over a single injection for major shoulder surgery. However, these trials did not administer a multimodal analgesic regimen. This randomized, controlled unblinded trial tested the hypothesis that a continuous infusion of local anesthetic for an interscalene brachial plexus block still provides superior analgesia after major shoulder surgery when compared with a single injection in the setting of multimodal analgesia, inclusive of intravenous dexamethasone, magnesium, acetaminophen and ketorolac.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Sixty patients undergoing shoulder arthroplasty or arthroscopic rotator cuff repair were randomized to receive a bolus of ropivacaine 0.5%, 20\u2009mL, with or without a continuous infusion of ropivacaine 0.2% 4\u20138\u2009mL\/hour, for an interscalene brachial plexus block. Patients were provided with intravenous morphine patient-controlled analgesia. The primary outcome was cumulative intravenous morphine consumption at 24\u2009hours postoperatively. Secondary outcomes included pain scores at rest and on movement, and functional outcomes, measured over 48\u2009hours after surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Median (IQR) cumulative intravenous morphine consumption at 24\u2009hours postoperatively was 10\u2009mg (4\u201324) in the continuous infusion group and 14\u2009mg (8\u201326) in the single injection group (p=0.74). No significant between-group differences were found for any of the secondary outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A continuous infusion of local anesthetic for an interscalene brachial plexus block does not provide superior analgesia after major shoulder surgery when compared with a single injection in the setting of multimodal analgesia, inclusive of intravenous dexamethasone, magnesium, acetaminophen and ketorolac. The findings of this study are limited by performance and detection biases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04394130\">NCT04394130<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2023-104681","type":"journal-article","created":{"date-parts":[[2023,8,4]],"date-time":"2023-08-04T11:10:19Z","timestamp":1691147419000},"page":"313-319","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Single-bolus injection of local anesthetic, with or without continuous infusion, for interscalene brachial plexus block in the setting of multimodal analgesia: a randomized controlled unblinded trial"],"prefix":"10.1136","volume":"49","clinical-trial-number":[{"clinical-trial-number":"nct04394130","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04394130","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6279-6484","authenticated-orcid":false,"given":"Patrick","family":"Rhyner","sequence":"first","affiliation":[{"name":"Department of Anesthesia, CHUV, Lausanne, Vaud, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthieu","family":"Cachemaille","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, CHUV, Lausanne, Vaud, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Goetti","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, CHUV, Lausanne, Vaud, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Benoit","family":"Rossel","sequence":"additional","affiliation":[{"name":"Primary Care and Public Health Center (Unisant\u00e9), University of Lausanne, Lausanne, Vaud, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Boand","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, CHUV, Lausanne, Vaud, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Farron","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, CHUV, Lausanne, Vaud, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6432-1311","authenticated-orcid":false,"given":"Eric","family":"Albrecht","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, CHUV, Lausanne, Vaud, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,8,4]]},"reference":[{"key":"2025090415171305000_49.5.313.1","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1213\/ANE.0000000000001581","article-title":"Continuous peripheral nerve blocks: an update of the published evidence and comparison with novel, alternative analgesic modalities","volume":"124","author":"Ilfeld","year":"2017","journal-title":"Anesth Analg"},{"key":"2025090415171305000_49.5.313.2","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/j.bja.2017.11.104","article-title":"Should continuous rather than single-injection interscalene block be routinely offered for major shoulder surgery? A meta-analysis of the analgesic and side-effects profiles","volume":"120","author":"Vorobeichik","year":"2018","journal-title":"Br J Anaesth"},{"key":"2025090415171305000_49.5.313.3","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1007\/s11999-013-3192-3","article-title":"Single-injection or continuous femoral nerve block for total knee Arthroplasty","volume":"472","author":"Albrecht","year":"2014","journal-title":"Clinical Orthopaedics & Related Research"},{"key":"2025090415171305000_49.5.313.4","doi-asserted-by":"publisher","DOI":"10.1053\/rapm.2003.50033"},{"key":"2025090415171305000_49.5.313.5","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000436607.40643.0a"},{"key":"2025090415171305000_49.5.313.6","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1001\/jamasurg.2017.0898","article-title":"Postoperative Multimodal analgesia pain management with Nonopioid Analgesics and techniques: a review","volume":"152","author":"Wick","year":"2017","journal-title":"JAMA Surg"},{"key":"2025090415171305000_49.5.313.7","doi-asserted-by":"crossref","first-page":"e98","DOI":"10.1016\/j.bja.2018.10.058","article-title":"Multicentre, prospective, double-blind, randomised controlled clinical trial comparing different non-opioid analgesic combinations with morphine for postoperative analgesia: the OCTOPUS study","volume":"122","author":"Beloeil","year":"2019","journal-title":"Br J Anaesth"},{"key":"2025090415171305000_49.5.313.8","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1093\/bja\/aex191","article-title":"Efficacy of Perineural vs systemic dexamethasone to prolong analgesia after peripheral nerve block: a systematic review and meta-analysis","volume":"119","author":"Baeriswyl","year":"2017","journal-title":"Br J Anaesth"},{"key":"2025090415171305000_49.5.313.9","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2012.07335.x"},{"key":"2025090415171305000_49.5.313.10","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aer107"},{"key":"2025090415171305000_49.5.313.11","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3182334d68"},{"key":"2025090415171305000_49.5.313.12","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1000251","article-title":"CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials","volume":"7","author":"Schulz","year":"2010","journal-title":"PLoS Med"},{"key":"2025090415171305000_49.5.313.13","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.22039"},{"key":"2025090415171305000_49.5.313.14","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1007\/s00540-013-1681-x","article-title":"Effective analgesia with ultrasound-guided interscalene brachial plexus block for postoperative pain control after Arthroscopic rotator cuff repair","volume":"28","author":"Shin","year":"2014","journal-title":"J Anesth"},{"key":"2025090415171305000_49.5.313.15","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0b013e31816151ab"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2023-104681","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T22:17:19Z","timestamp":1757024239000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2023-104681"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,4]]},"references-count":15,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5,7]]},"published-print":{"date-parts":[[2024,5]]}},"alternative-id":["10.1136\/rapm-2023-104681"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2023-104681","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,4]]}}}