Abstract
Purpose
To investigate the postoperative analgesic effect of subacromial patient-controlled analgesia (SA-PCA) with ropivacaine in comparison with intravenous patient-controlled analgesia (IV-PCA) after arthroscopic rotator cuff repair.
Methods
Sixty patients were prospectively randomized into one of the two types of analgesics for 48 h after the operation. In the SA-PCA group, patients received 0.5% ropivacaine at a rate of 2 ml/h with a patient-controlled bolus dose of 2 ml. In the IV-PCA group, patients received intravenous patient-controlled analgesia. Pain relief was regularly assessed using visual analog scale (VAS) for 48 h, and side effects were noted.
Results
The postoperative pain VAS at 1 h after the operation was lower for the SA-PCA group (4.3 ± 2.7) than for the IV-PCA group (6.3 ± 2.6, P = 0.009). The frequency of requested bolus doses by patients in the IV-PCA (19 ± 19) was higher than in the SA-PCA (7 ± 10, P = 0.04). Rescue opioid or NSAID requirements were not different. More patients in the IV-PCA (17/30) experienced nausea than in the SA-PCA (7/30, P = 0.03). Patient satisfaction was higher in the SA-PCA than in the IV-PCA [6.7 (3–10) vs. 5.6 (0–8), P = 0.04]. The mean total venous plasma concentration of ropivacaine at 8 and 24 h was below the maximum tolerated venous plasma concentration, and symptoms of systemic toxicity were not noted during 48 h in the SA-PCA.
Conclusions
The analgesic effect of subacromial patient-controlled analgesia with ropivacaine was better than intravenous analgesia during the immediate postoperative period with fewer side effects.
Level of evidence
Therapeutic study, Level I.
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Acknowledgments
The authors would like to thank Hye Ran Kim and Shang Mi Shim for their assistance with data collection.
Conflict of interest
This study is supported by grant to 04-2008-008 from the SNUBH Research Fund. There was no potential benefit to the company from this article. No product of the company was mentioned.
Ethical board review
All authors certifies that his or her institution has approved (This work was performed at Seoul National University College of medicine, Seoul National University Bundang hospital, IRB Number; B-1103/124-106) the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research.
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The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article and have no potential conflicts of interest related to this manuscript.
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Yun, M.J., Oh, J.H., Yoon, J.P. et al. Subacromial patient-controlled analgesia with ropivacaine provides effective pain control after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 20, 1971–1977 (2012). https://doi.org/10.1007/s00167-011-1841-1
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DOI: https://doi.org/10.1007/s00167-011-1841-1