Supraclavicular block with Mepivacaine vs Ropivacaine, their impact on postoperative pain: a prospective randomised study

Irén Sellbrant, Jon Karlsson, Jan G Jakobsson, Bengt Nellgård, Irén Sellbrant, Jon Karlsson, Jan G Jakobsson, Bengt Nellgård

Abstract

Background: Supraclavicular block (SCB) with long-acting local anaesthetic is commonly used for surgical repair of distal radial fractures (DRF). Studies have shown a risk for rebound pain when the block fades. This randomised single-centre study aimed to compare pain and opioid consumption the first three days post-surgery between SCB-mepivacaine vs. SCB-ropivacaine, with general anaesthesia (GA) as control.

Methods: Patients (n = 90) with ASA physical status 1-3 were prospectively randomised to receive; SCB with mepivacine 1%, 25-30 ml (n = 30), SCB with ropivacaine 0.5%, 25-30 ml (n = 30) or GA (n = 30) with propofol/fentanyl/sevoflurane. Study objectives compared postoperative pain with Numeric Rating Scale (NRS) and sum postoperative Opioid Equivalent Consumption (OEC) during the first 3 days post-surgery between study-groups.

Results: The three groups showed significant differences in postoperative pain-profile. Mean NRS at 24 h was significantly lower for the SCB-mepivacaine group (p = 0.018). Further both median NRS and median OEC day 0 to 3 were significanly lower in the SCB-mepivacaine group as compared to the SCB-ropivacaine group during the first three days after surgery; pain NRS 1 (IQR 0.3-3.3) and 2.7 (IQR 1.3-4.2) (p = 0.017) and OEC 30 mg (IQR 10-80) and 85 mg (IQR 45-125) (p = 0.004), respectively. The GA-group was in between both in pain NRS and median sum OEC. Unplanned healthcare contacts were highest among SCB-ropivacaine patients (39.3%) vs. SCB-mepivacaine patients (0%) and GA-patients (3.4%).

Conclusions: The potential benefit of longer duration of analgesia, associated to a long-acting local anaesthetic agent, during the early postoperative course must be put in perspective of potential worse pain progression following block resolution.

Trial registration: NCT03749174 (clinicaltrials.gov, Nov 21, 2018, retrospectively registered).

Keywords: Day surgery; Distal radial fracture; Local anaesthetics; Opioid consumption; Postoperative pain; Rebound pain; Supraclavicular plexus block.

Conflict of interest statement

JJ has also been paid lecturer for Abbot, MSD, Pfizer, Baxter and Mundipharma. Jan Jakobsson has received unrestricted research grants from Abbott, Baxter, MSD and Maquet.

JK is Editor-in-Chief of Knee Surgery Sports Traumatology Arthroscopy (KSSTA).

The other authors declares that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
CONSORT Flowchart. Flow of patients through trial. SCB = supraclavicular block and GA = general anaesthesia
Fig. 2
Fig. 2
Mean NRS pain scores (range, 0–10) preoperative/baseline and four postoperative times are showing the postoperative pain pattern for the three anaesthetic groups. Postdischarge from hospital a differences between the 2 SCB-groups was noted at 24 h * (p = 0.018)

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