Donnelly Clinical Research
From UWSMPH - Department of Anesthesiology
Melanie Donnelly, MD, MPH
"Duration of analgesic effect for ultrasound guided supraclavicular blocks with the addition of buprenorphine to local anesthetic solution"
Numerous surgical procedures involving the upper extremity below the shoulder are performed in the ambulatory surgery center at this institution on a weekly basis. Nearly all of these patients are offered a brachial plexus block (BPB) as their primary anesthetic. These single injection nerve blocks are generally accomplished with bupivacaine and can provide approximately10-20 hours of analgesia1 which also allows these patients analgesia in the early postoperative period. The technique is left to the discretion of the anesthesiologist performing the block. Possible techniques include supraclavicular, infraclavicular, and axillary approaches to the BPB. Usually 20-30 mL of 0.5% bupivacaine + 2.5 mcg/mL epinephrine (BE) is used. All blocks are placed under ultrasound guidance (USG) with nerve stimulation. These blocks last around 12 hours to provide analgesia and patients frequently report intense pain after the block wears off. Because surgery typically takes place between the hours of 8am and 2pm this leaves patients with a no intact analgesic, from our procedure, during the first night after surgery. Buprenorphine is an opioid agonist-antagonist that has been used as an additive for nerve blocks. It has been shown to extend the duration of analgesia for certain nerve blocks.
For patients undergoing upper extremity surgery in the outpatient setting and receiving a supraclavicular brachial plexus block (SBPB) as their primary anesthetic, we would like to compare the duration and quality of pain control in patients that received a single injection SBPB nerve block with BE versus with BE plus buprenorphine (BEB). We plan to use USG to visualize each patient’s anatomy. We hope to show that buprenorphine will extend the duration of the block we place in a clinically meaningful way.
"ACL repair and multimodal analgesia"
This study evaluates a multimodal pain control regimen in patients having ACL surgery using hamstring grafts performed by one orthopedic surgeon. The multimodal group will receive gabapentin, acetaminophen and a femoral nerve block pre-operatively. They will receive a ketamine infusion and ketorolac during the case, in addition to local anesthetic infiltration by the surgeon along the route of hamstring graft harvest. This would be compared with a standard anesthetic performed for the same procedure. A standard anesthetic will include a pre-operative femoral nerve block. Intra-operatively it will include ketorolac administration. Both groups will receive intra-articular meperidine. The primary outcome will be narcotic use in the immediate perioperative period. The hypothesis would be that there will be a 50% reduction opioid use during the immediate recovery time period spent in the outpatient surgery center in the group receiving multimodal analgesia.
"Continuous interscalene block versus single injection interscalene block in those undergoing shoulder surgery in the ambulatory setting"
The current standard of care for major shoulder surgery is a brachial plexus block for post-operative analgesia. That may be administered in the form a single injection interscalene block or continuous infusion via a perineural (next to the nerve) catheter placed in the interscalene space. Single injection blocks can provide 12-24 hours of analgesia and a continuous infusion can extend analgesia to 3 days.
This study will recruit up to 154 participants who will undergo shoulder surgery (rotator cuff repair, subacromial decompression, labral repair, SLAP repair) to examine whether sending patients home with continuous infusions results in better pain relief than single injection alone. The primary outcome measure will be pain scores on post-operative Day 1. Secondary outcome measures include incidence of opioid side effects; incidence of complications related to the nerve catheter and block; rehabilitation and functional outcome and quality of life.