Continuous Interscalene Blocks and Rebound Pain

NCT07770165 | Not Yet Recruiting

• 1 other identifier: REB26-1309
• Study Type: interventional
• Target: 154
• Locations: 1 country
• Sites: 1

Brief Summary

The primary objectives of this present study are to examine whether a continuous interscalene block of a total duration of 48 hours reduces the incidence of rebound pain comparatively to single-shot interscalene block, through the evaluation of the NRS scores at rest and on movement in the postoperative period at 24, 48, 72 and 96 hours as well as the total opioid consumption in the same timeframe for patients undergoing total shoulder arthroplasty. Rebound pain has been defined in some studies as the "the transition from well-controlled pain (numerical rating scale \[NRS\] ≤3) while the block is working to severe pain (NRS ≥7) within 24 h of block performance."

Conditions

Reverse Total Shoulder Arthroplasty; Interscalene Analgesia; Interscalene Nerve Block; Orthopedic Surgery Patients; Locoregional Anaesthesia; Rebound Pain; Total Shoulder Arthroplasty; Interscalene Blocks

Keywords

Interscalene; Nerve Block; Catheter; Continuous Interscalene Block; Total Shoulder Arthroplasty; Reverse Total Shoulder Arthroplasty; Rebound Pain

Outcome Measures

Primary Outcomes (1)

• incidence of Rebound pain within 96 hours postoperatively

  The incidence of Rebound Pain, defined as an NRS score of \< 3 during an effective block to an NRS \> 7 within 24 hours of block resolution. This will be analyzed as a binary variable (yes/no)

  This outcome will be measured within 24 hours of block resolution, for up to 96 hours after the initial block realization.

Study Arms (2)

Single Shot Interscalene Block

ACTIVE COMPARATOR

This Control Group will receive a single-shot interscalene block, which is considered one of the standard of care analgesic modality for shoulder surgery.

Drug: Interscalene Block

Continuous Interscalene Block

EXPERIMENTAL

This Interventional Group will receive a continuous interscalene block via a catheter for a duration of 48 hours with ropivacaine 0.2% at a fixed 5 mL/hour rate.

Drug: Continuous interscalene nerve block

Interventions

Continuous interscalene nerve block DRUG

This Interventional Group will receive a continuous interscalene block via a catheter for a duration of 48 hours with ropivacaine 0.2% at a fixed 5 mL/hour rate.

Continuous Interscalene Block

Interscalene Block DRUG

This control group will receive a single shot interscalene block with 20 mL of ropivicaine 0.2%.

Single Shot Interscalene Block

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adults aged \>18 years of age
• ASA I-III
• Scheduled for elective ambulatory total shoulder arthroplasty.

You may not qualify if:

• ASA IV
• Revision surgery
• Contraindication to regional anesthesia (such as allergy to local anesthetics, systemic anticoagulation, local infection)
• Preoperative chronic pain or opioid use
• Preoperative drug dependency
• Severe respiratory disease or contralateral diaphragmatic paralysis
• Patient refusal.

Sponsors & Collaborators

• University of Calgary: lead

Study Sites (1)

South Health Campus

Calgary, Alberta, T3M 1M4, Canada

Location

Related Publications (16)

• https://www.sciencedirect.com/science/article/pii/S2950553424000856

  BACKGROUND

• https://www.sciencedirect.com/science/article/pii/S0972978X20301756?via%3Dihub#bib20

  BACKGROUND

• https://www.nysora.com/regional-anesthesia/techniques/upper-extremity/intescalene/ultrasound-guided-interscalene-brachial-plexus-block/

  BACKGROUND

• https://www.ovid.com/jnls/co-anesthesiology/fulltext/10.1097/aco.0000000000000651~rebound-pain-after-regional-anesthesia-in-the-ambulatory

  BACKGROUND

• https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.16583

  BACKGROUND

• https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.70249

  BACKGROUND

• Williams BA, Bottegal MT, Kentor ML, Irrgang JJ, Williams JP. Rebound pain scores as a function of femoral nerve block duration after anterior cruciate ligament reconstruction: retrospective analysis of a prospective, randomized clinical trial. Reg Anesth Pain Med. 2007 May-Jun;32(3):186-92. doi: 10.1016/j.rapm.2006.10.011.

  PMID: 17543812 BACKGROUND

• Barry GS, Bailey JG, Sardinha J, Brousseau P, Uppal V. Factors associated with rebound pain after peripheral nerve block for ambulatory surgery. Br J Anaesth. 2021 Apr;126(4):862-871. doi: 10.1016/j.bja.2020.10.035. Epub 2020 Dec 31.

  PMID: 33390261 BACKGROUND

• Rhyner P, Cachemaille M, Goetti P, Rossel JB, Boand M, Farron A, Albrecht E. 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. Reg Anesth Pain Med. 2024 May 7;49(5):313-319. doi: 10.1136/rapm-2023-104681.

  PMID: 37541683 BACKGROUND

• Hussain N, Goldar G, Ragina N, Banfield L, Laffey JG, Abdallah FW. Suprascapular and Interscalene Nerve Block for Shoulder Surgery: A Systematic Review and Meta-analysis. Anesthesiology. 2017 Dec;127(6):998-1013. doi: 10.1097/ALN.0000000000001894.

  PMID: 28968280 BACKGROUND

• Kim HJ, Koh KH, Park JI, Kim YJ, Kim MJ, Kim H, Kim H, Ro YJ, Koh WU. Comparison of the Analgesic Efficacy between Arthroscopically Placed Continuous Suprascapular Nerve Block and Ultrasound-guided Continuous Superior Trunk Block: A Double-blinded Randomized Controlled Trial. Anesthesiology. 2023 Nov 1;139(5):591-601. doi: 10.1097/ALN.0000000000004691.

  PMID: 37450621 BACKGROUND

• Pai B H P, Bohaczuk S, Jinadu S, Hong J, Echevarria G, Lai YH, Chen J, Cagle PJ, Flatow EL, Rosenblatt M. Comparison of analgesic efficacy of continuous perineural catheter, liposomal bupivacaine, and dexamethasone as an adjuvant for interscalene block in total shoulder arthroplasty: a triple-blinded randomized controlled trial. J Shoulder Elbow Surg. 2025 Feb;34(2):e81-e92. doi: 10.1016/j.jse.2024.06.014. Epub 2024 Aug 27.

  PMID: 39197650 BACKGROUND

• Xiao M, Cohen SA, Cheung EV, Freehill MT, Abrams GD. Pain management in shoulder arthroplasty: a systematic review and network meta-analysis of randomized controlled trials. J Shoulder Elbow Surg. 2021 Nov;30(11):2638-2647. doi: 10.1016/j.jse.2021.06.008. Epub 2021 Jul 17.

  PMID: 34284094 BACKGROUND

• Trudeau MT, Peters JJ, LeVasseur MR, Hawthorne BC, Dorsey CG, Wellington IJ, Shea KP, Mazzocca AD. Inpatient versus outpatient shoulder arthroplasty outcomes: A propensity score matched risk-adjusted analysis demonstrates the safety of outpatient shoulder arthroplasty. J ISAKOS. 2022 Apr;7(2):51-55. doi: 10.1016/j.jisako.2022.01.001. Epub 2022 Jan 25.

  PMID: 35546436 BACKGROUND

• Woodmass J, Harris S, McRae S, Righolt CH, MacDonald P, Bohm E. Implementation of and findings from a regional shoulder replacement registry. Can J Surg. 2026 Mar 31;69(2):E137-E145. doi: 10.1503/cjs.014624. Print 2026 Mar-Apr.

  PMID: 41916651 BACKGROUND

• Rupani N, Combescure C, Silman A, Lubbeke A, Rees J. International trends in shoulder replacement: a meta-analysis from 11 public joint registers. Acta Orthop. 2024 Jun 18;95:348-357. doi: 10.2340/17453674.2024.40948.

  PMID: 38888103 BACKGROUND

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: The anesthesiologist responsible for block or catheter placement, the attending anesthesiologist, surgeons, and patients will not be blinded to their intervention. However, the responsible party for conducting postoperative follow-up phone assessments at 24, 48, 72, and 96 hours will be blinded to treatment allocation.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: This is a pragmatic randomized controlled, parallel group, single-blinded trial comparing a single-shot interscalene block (control group) to a catheter-based continuous interscalene block (treatment group) placed preoperatively in total shoulder arthroplasty patients.

Study Record Dates

• First Submitted: August 12, 2026
• First Posted: August 18, 2026
• Study Start: October 1, 2026
• Primary Completion (Estimated): May 1, 2027
• Study Completion (Estimated): May 1, 2027
• Last Updated: August 19, 2026

Record last verified: 2026-07

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)