Efficacy of Nerve Blockade Performed Prior to Surgical Intervention Versus Following Surgical Intervention
Efficacy of Nerve Blockade Performed Prior to Surgical Intervention Versus Following Surgical Intervention
Nerve blocks, or pain medication injected next to the nerve while patients are asleep, are
 commonly used for pain management after shoulder surgery and are considered highly effective
 in decreasing post-operative pain. There are several different ways to give a nerve block.
 All are effective and safe. The purpose of this research is to determine if one of the
 available ways to give a nerve block is more effective than the others.
Interscalene brachial plexus blockade is commonly performed to provide relief of
 postoperative pain following surgical shoulder repair. This has proven to be a reliable means
 of reducing the required doses of intraoperative and postoperative opiates and effectively
 delaying postoperative pain, as well as hastening patient discharge and increasing patient
 satisfaction. Neural blockade has traditionally been performed prior to surgery with the hope
 that preemptive analgesia will most effectively abate postoperative pain. Recently, however,
 it has been argued that sensitization to pain can be attributed to many factors, not solely
 the nociceptive battery associated with incision and subsequent intraoperative events. The
 duration of action and effectiveness of the treatment modality thus appear play a more
 important role than the actual timing of the treatment delivered. The safety and efficacy of
 performing interscalene brachial plexus blockade under general anesthesia has recently been
 reported as being not only safe, but perhaps more effective than when performed in an awake
 patient. We propose a randomized prospective evaluation of the analgesic efficacy comparing
 interscalene brachial plexus blockade performed prior to surgery with interscalene brachial
 plexus blockade performed following the completion of of surgery in healthy ASA I and II
 adolescent patients undergoing unilateral shoulder reconstruction on an outpatient basis.
Inclusion Criteria:

 -  The subject is male or female;

 -  The subject is of any racial and ethnic groups;

 -  The subject is age 10 years to 21 years (inclusive);

 -  The subject is scheduled for the following

 -  Unilateral shoulder repair under general anesthesia on an out- patient basis, and not
 being performed in conjunction with any other surgical procedures;

 -  Agreement of the surgeon for subject participation in study.

 -  The subject or legally authorized representative has consented to an intra- scalene
 block for the procedure and the consent for the block has been obtained by an
 clinician (MD, DO, CRNA or APN) authorized to obtain consent who is independent of the
 study team

 -  The subject is American Society of Anesthesiologists (ASA) patient classification
 I-II;

 -  The subject's legally authorized representative has given written informed consent to
 participate in the study and when appropriate, the subject has given assent or consent
 to participate.

 Exclusion Criteria:

 -  Additional surgical procedures are being performed concurrently;

 -  The subject is ASA classification > II;

 -  The subject has pre-existing allergies to local anesthetics;

 -  The subject receives sedation preoperatively;

 -  The subject has an imminent life threatening condition that impacts the ability to
 obtain informed consent;

 -  The subject has any other condition, which in the opinion of the principal
 investigator, would not be suitable for participation in the study, including but not
 limited preexisting neuropathy.