Advertisement

Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 19, Issue 10, pp 1744–1748 | Cite as

Multimodal approach to postoperative pain control in patients undergoing rotator cuff repair

  • Chul-Hyun ChoEmail author
  • Kwang-Soon Song
  • Byung-Woo Min
  • Kyung-Jae Lee
  • Eunyoung Ha
  • Yong-Chul Lee
  • Young-Kuk Lee
Shoulder

Abstract

Purpose

This prospective study was undertaken to compare the effectiveness and safety of a multimodal pain control protocol with those of intravenous patient-controlled analgesia in rotator cuff repair.

Methods

Seventy patients scheduled for rotator cuff repair were randomized to either a multimodal pain control group (group 1, 40 patients) or an intravenous patient-controlled analgesia group (group 2, 30 patients). We compared these two groups with respect to level of pain before surgery to the fifth postoperative day, duration of postoperative rehabilitation, consumption of additional analgesics, and adverse effects.

Results

Mean visual analogue scale scores immediately after surgery (day 0) and on postoperative days 1–5 were 6.9, 5.5, 4.3, 3.3, 3.0, and 2.6 in group 1 and 7.8, 5.9, 4.4, 4.7, 4.3, and 3.7 in group 2. Pain relief was significantly better in group 1 on days 0, 3, 4, and 5 (P = 0.026, 0.006, 0.010, and 0.009, respectively). Furthermore, functional recovery occurred earlier in group 1. No significant differences were observed between the two groups with respect to nausea, vomiting, urinary retention, and headache (n.s.), but group 1 was found to be significantly less likely to experience dizziness or urticaria (P = 0.007, 0.017, respectively). One other significant difference was observed: 1 patient (2.5%) in group 1 and 6 patients (20%) in group 2 discontinued regimen because of medication-related adverse effects (P = 0.016).

Conclusion

The multimodal pain control protocol was found to offer more effective postoperative pain control with fewer adverse effects than intravenous patient-controlled analgesia. However, achieving adequate pain control within the first 48 h of surgery remains challenging, and thus, the developments of more effective and safer multimodal pain control protocols are required.

Keywords

Rotator cuff repair Postoperative pain control Multimodal approach 

References

  1. 1.
    Albert TJ, Cohn JC, Rothman JS, Springstead J, Rothman RH, Booth RE Jr (2001) Patient-controlled analgesia in a postoperative total joint arthroplasty population. J Arthroplasty 6:23–28CrossRefGoogle Scholar
  2. 2.
    Bishop JY, Sprague M, Gelber J, Krol M, Rosenblatt MA, Gladstone J, Flatow EL (2005) Interscalene regional anesthesia for shoulder surgery. J Bone Joint Surg Am 87:974–979PubMedCrossRefGoogle Scholar
  3. 3.
    Boss AP, Maurer T, Seiler S, Aeschbach A, Hintermann B, Strebel S (2004) Continuous subacromial bupivacaine infusion for postoperative analgesia after open acromioplasty and rotator cuff repair: preliminary results. J Shoulder Elbow Surg 13:630–634PubMedCrossRefGoogle Scholar
  4. 4.
    Burns JW, Hodsman NB, McLintock TT, Gillies GW, Kenny GN, McArdle CS (1989) The influence of patient characteristics on the requirements for postoperative analgesia: a reassessment using patient-controlled anesthesia. Anaesthesia 44:2–6PubMedCrossRefGoogle Scholar
  5. 5.
    Capdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubenovitch J, d’Athis F (1999) Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology 91:8–15PubMedCrossRefGoogle Scholar
  6. 6.
    Cho NS, Ha JH, Rhee YG (2007) Patient-controlled analgesia after arthroscopic rotator cuff repair: subacromial catheter versus intravenous injection. Am J Sports Med 35:75–79PubMedCrossRefGoogle Scholar
  7. 7.
    Cohen DB, Kawamura S, Ehteshami JR, Rodeo SA (2006) Indomethacin and celecoxib impair rotator cuff tendon-to-bone healing. Am J Sports Med 34:362–369PubMedCrossRefGoogle Scholar
  8. 8.
    Dorr LD, Raya J, Long WT, Boutary M, Sirianni LE (2008) Multimodal analgesia without parenteral narcotics for total knee arthroplasty. J Arthroplasty 23:502–508PubMedCrossRefGoogle Scholar
  9. 9.
    Elvir-Lazo OL, White PF (2010) Postoperative pain management after ambulatory surgery: role of multimodal analgesia. Anesthesiol Clin 28:217–224PubMedCrossRefGoogle Scholar
  10. 10.
    Filos KS, Lehmann KA (1999) Current concepts and practice in postoperative pain management: need for a change? Eur Surg Res 31:91–107CrossRefGoogle Scholar
  11. 11.
    Hartrick CT (2004) Multimodal postoperative pain management. Am J Health Syst Pharm 61:4–10Google Scholar
  12. 12.
    Heard SO, Edwards WT, Ferrari D, Hanna D, Wong PD, Liland A, Willock MM (1992) Analgesic effect of intraarticular bupivacaine or morphine after arthroscopic knee surgery: a randomized, prospective, double-blind study. Anesth Analg 74:822–826PubMedCrossRefGoogle Scholar
  13. 13.
    Horlocker TT, Hebl JR, Kinney MA, Cabanela ME (2002) Opioid-free analgesia following total knee arthroplasty—a multimodal approach using continuous lumbar plexus (psoas compartment) block, acetaminophen, and ketorolac. Reg Anesth Pain Med 27:105–108PubMedGoogle Scholar
  14. 14.
    Jaureguito JW, Wilcox JF, Cohn SJ, Thisted RA, Reider B (1995) A comparison of intraarticular morphine and bupivacaine for pain control after outpatient knee arthroscopy: a prospective, randomized, double-blinded study. Am J Sports Med 23:350–353PubMedCrossRefGoogle Scholar
  15. 15.
    Jin F, Chung F (2001) Multimodal analgesia for postoperative pain control. J Clin Anesth 17:524–539CrossRefGoogle Scholar
  16. 16.
    Joshi GP (2005) Multimodal analgesia techniques and postoperative rehabilitation. Anesthesiol Clin North America 23:185–202PubMedCrossRefGoogle Scholar
  17. 17.
    Oh JH, Kim WS, Kim JY, Gong HS, Rhee GY (2007) Continuous intralesional infusion combined with interscalene block was effective for postoperative analgesia after arthroscopic shoulder surgery. J Shoulder Elbow Surg 16:295–299PubMedCrossRefGoogle Scholar
  18. 18.
    Parvataneni HK, Ranawat AS, Ranawat CS (2007) The use of local periarticular injections in the management of postoperative pain after total hip and knee replacement: a multimodal approach. Instr Course Lect 56:125–131PubMedGoogle Scholar
  19. 19.
    Parvizi J, Porat M, Gandhi K, Viscusi ER, Rothman RH (2009) Postoperative pain management techniques in hip and knee arthroplasty. Instr Course Lect 58:769–779PubMedGoogle Scholar
  20. 20.
    Ready LB (1999) Acute pain: lessons learned from 25,000 patients. Reg Anesth Pain Med 24:499–505PubMedGoogle Scholar
  21. 21.
    Ruiz-Suarez M, Barber FA (2008) Postoperative pain control after shoulder arthroscopy. Orthopedics 31:1130PubMedCrossRefGoogle Scholar
  22. 22.
    Scoggin JF, Mayfield G, Awaya DJ, Pi M, Prentiss J, Takahashi J (2002) Subacromial and intra-articular morphine versus bupivacaine after shoulder surgery. Arthroscopy 18:464–468PubMedCrossRefGoogle Scholar
  23. 23.
    Sinatra RS, Torres J, Bustos AM (2002) Pain management after major orthopaedic surgery: current strategies and new concepts. J Am Acad Orthop Surg 10:117–129PubMedGoogle Scholar
  24. 24.
    Skinner HB (2004) Multimodal acute pain management. Am J Orthop 33:5–9PubMedCrossRefGoogle Scholar
  25. 25.
    Tang R, Evans H, Chaput A, Kim C (2009) Multimodal analgesia for hip arthroplasty. Orthop Clin North Am 40:377–387PubMedCrossRefGoogle Scholar
  26. 26.
    Tempfer H, Gehwolf R, Lehner C, Wagner A, Mtsariashvili M, Bauer HC, Resch H, Tauber M (2009) Effects of crystalline glucocorticoid triamcinolone acetonide on cultered human supraspinatus tendon cells. Acta Orthop 80:357–362PubMedCrossRefGoogle Scholar
  27. 27.
    Vendittoli PA, Makinen P, Drolet P, Lavigne M, Fallaha M, Guertin MC, Varin F (2006) A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. J Bone Joint Surg Am 88:282–289PubMedCrossRefGoogle Scholar
  28. 28.
    Viscusi ER (2004) Emerging techniques for postoperative analgesia in orthopedic surgery. Am J Orthop 33:13–16PubMedCrossRefGoogle Scholar
  29. 29.
    White PF (2008) Multimodal analgesia: its role in preventing postoperative pain. Curr Opin Investig Drugs 9:76–78PubMedGoogle Scholar
  30. 30.
    Woolf CJ, Chong MS (1993) Preemptive analgesia-treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 77:362–379PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Chul-Hyun Cho
    • 1
    Email author
  • Kwang-Soon Song
    • 1
  • Byung-Woo Min
    • 1
  • Kyung-Jae Lee
    • 1
  • Eunyoung Ha
    • 1
  • Yong-Chul Lee
    • 2
  • Young-Kuk Lee
    • 3
  1. 1.Department of Orthopedic Surgery, Pain Research Center, Dongsan Medical Center, School of MedicineKeimyung UniversityDaeguKorea
  2. 2.Department of Anesthesiology, Dongsan Medical Center, School of MedicineKeimyung UniversityDaeguKorea
  3. 3.Department of Orthopedic SurgeryBeauty Korea HospitalDaeguKorea

Personalised recommendations