VOL. 88-B, No. 9, SEPTEMBER 2006 1173 Continuous interscalene infusion and single injection using levobupivacaine for analgesia after surgery of the shoulder A DOUBLE-BLIND, RANDOMISED CONTROLLED TRIAL J. Kean, C. A. Wigderowitz, D. M. Coventry From Ninewells Hospital, Dundee, Scotland  J. Kean, MB ChB, BMSc, Surgical House Officer  C. A. Wigderowitz, MD, PhD, FRCS Ed, Orthopaedic Surgeon Department of Orthopaedic and Trauma Surgery  D. M. Coventry, MB ChB, FRCA, Consultant Anaesthetist Department of Anaesthesia Ninewells Hospital and Medical School, TORT Building, Dundee DD1 9SY, UK. Correspondence should be sent to Mr C. A. Wigderowitz; e-mail: cawigderowitz@lineone.net ©2006 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.88B9. 17412 $2.00 J Bone Joint Surg [Br] 2006;88-B:1173-7. Received 14 November 2005; Accepted after revision 18 May 2006 We performed a double-blind, randomised controlled trial to assess the effectiveness of a continuous-infusion brachial plexus block with levobupivacaine compared with that of a standard single injection for the management of post-operative pain after surgery on the shoulder. Eight patients were randomised to receive a pre-operative brachial plexus block using 30 ml of levobupivacaine 0.5% with adrenaline 1:200 000 followed by insertion of a 20-gauge polyamide catheter. This was connected to a disposable elastometric pump, set immediately after surgery to administer a continuous flow of levobupivacaine 0.25% at a rate of 5 ml per hour. The other eight patients were randomised to receive only the initial injection of 30 ml. The study was double-blinded with the aid of sham catheters and clamped pumps. All patients were given regular paracetamol and were prescribed morphine through a patient-controlled analgesia pump. Motor and sensory block assessments, visual analogue scale pain scores and consumption of morphine were recorded after the operation and then at 6, 12 and 24 hours after administration of the block. Satisfactory motor and sensory block was achieved in all patients. The mean visual analogue scale pain score at 12 hours and consumption of morphine at 24 hours after injection were significantly lower (p < 0.05) in the continuous-infusion group. This group also took longer to request their first additional analgesia and reported a significantly higher overall level of satisfaction. Our study has shown that continuous interscalene infusion of levobupivacaine is an effective method of post-operative analgesia after major surgery of the shoulder. The use of local and regional anaesthetic tech- niques is becoming more popular because they offer the advantages of excellent post-oper- ative relief from pain, and the ability to eat, drink and mobilise soon after surgery while avoiding the risks and side-effects of general anaesthesia. 1 In a meta-analysis Rodgers et al 2 suggested that mortality associated with major surgery was reduced by 30% when regional anaesthesia was used, with or without general anaesthesia. This may be related to the many multisystem pathophysiological benefits out- lined by Herrick and Van Rooyen, 3 such as bet- ter maintenance of respiratory function, im- proved coronary blood flow and reduced myo- cardial oxygen demand. Local and regional techniques offer faster mobilisation of patients undergoing surgery to the upper limb, who may be fully ambulant on return to the ward and able to go home later that day. The quicker recovery of individual patients and minimised admission for post-operative pain, nausea or prolonged sedation allow an increased through- put of patients, thereby reducing costs. Regional anaesthetic techniques may be used on their own, or combined with general anaesthesia, to provide post-operative relief from pain. The current practice in shoulder surgery is to achieve a brachial plexus block with a long-acting local anaesthetic agent given in one dose immediately before surgery. This offers a period of analgesia post-operatively until the local anaesthetic wears off. However, brachial plexus block with a continuous in- fusion of local anaesthetic through a catheter and elastometric pump is now used in some centres in the United Kingdom and USA to provide effective and longer-lasting analge- sia. 4-7 There is also the possibility of delivering a later bolus of local anaesthetic through a catheter, or to set up a patient-controlled pump to deliver local anaesthetic as required. 8,9 Our aim was to assess the effectiveness of a continuous-infusion brachial plexus block with Upper limb