Postoperative analgesia for arthroscopic shoulder surgery: a prospective randomized controlled study of intraarticular, subacromial injection, interscalenic brachial plexus block and intraarticular plus subacromial injection efficacy.

Full Abstract

BACKGROUND AND OBJECTIVES: The aim of the present study was to compare the new combination of intraarticular + subacromial injection, with intraarticular, subacromial injection and interscalenic brachial plexus block as postoperative analgesia in shoulder arthroscopy. METHODS: One hundred and twenty patients scheduled for shoulder arthroscopy were enrolled and randomly assigned to one of five groups: intraarticular, subacromial, interscalenic brachial plexus block (IBPB), intraarticular + subacromial (intraarticular + subacromial) injection or a control group. All patients received standardized general anaesthesia and all the injections were given with the same dose and volume of local anaesthetic. The number of boluses (fentanyl 1 microg kg(-1) delivered by a patient-controlled analgesia pump applied at the end of the surgery and the visual analogue pain score (VAPS) at 0, 2, 4, 6, 12, 18 and 24 h after the intervention were recorded. A patient satisfaction score was also assessed at 24 h. RESULTS: Mean bolus consumption, compared with control group, was significantly less in all groups (P < 0.01). Intraarticular + subacromial group utilized fewer boluses compared with subacromial group and significantly lower boluses than intraarticular group (P < 0.01), but IBPB group utilized significantly fewer boluses than intraarticular + subacromial group. Patients in IBPB, intraarticular + subacromial and subacromial groups showed VAPSs that were significantly better than that of the control group at all time points (P < 0.01). The VAPS in intraarticular + subacromial group was statistically comparable with those in IBPB and subacromial groups at each time interval. IBPB and intraarticular + subacromial groups showed comparable patient satisfaction scores. CONCLUSION: These results confirm the analgesic efficacy of IBPB for shoulder surgery. Nonetheless, the combination of intraarticular and subacromial infiltration, studied for the first time, appears to be a clinically valid alternative with no clinical meaningful adverse effects.

Author information

Author/s: Fontana, Costantino (C); Di Donato, Attilio (A); Di Giacomo, Giovanni (G); Costantini, Alberto (A); De Vita, Andrea (A); Lancia, Fabrizio (F); Caricati, Alessio (A);

Affiliation: Department of Anaesthesia, Resuscitation and Pain Management, Concordia Hospital for Special Surgery, Rome, Italy. foncos(-atsign-)tiscali.it

Journal and publication information

Publication Type: Journal Article; Randomized Controlled Trial

Journal: European journal of anaesthesiology (Eur J Anaesthesiol), published in England. (Language: eng)

Reference: 2009-Aug; vol 26 (issue 8) : pp 689-93

Dates: Created 2009/07/10; Completed 2009/09/15;

PMID: 19593887, status: MEDLINE (last retrieval date: 9/15/2009, IMS Date: )

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