title: Intraarticular administration of ketorolac, morphine, and ropivacaine combined with intraarticular patient-controlled regional analgesia for pain relief after shoulder surgery: a randomized, double-blind study.
abstract: BACKGROUND
  In this study we assessed the efficacy of intraarticular regional analgesia on postoperative pain and analgesic requirements.
  
  
  METHODS
  Fifty-one patients undergoing shoulder surgery (Bankart) were recruited into this double-blind study. At the end of the operation, patients were randomized to three groups to receive intraarticularly via a catheter: Group 1: ropivacaine 90 mg (9 mL), morphine 4 mg (10 mL), and ketorolac 30 mg (1 mL) (total volume 20 mL); Groups 2 and 3: saline (20 mL). In addition, Groups 1 and 3 received 1 mL saline IV while Group 2 received ketorolac 30 mg (1 mL) IV. Postoperatively, Group 1 received pain relief using 10 mL 0.5% ropivacaine on demand via the intraarticular catheter while Groups 2 and 3 received 10 mL of saline intraarticularly. Group 3 was the Control group.
  
  
  RESULTS
  Postoperative pain at rest and on movement were lower in Group 1 than in Groups 2 and 3 during the first 30 and 120 min, respectively. The time to first request for local anesthetic infusion was longer in Group 1 than in Groups 2 and 3 (P < 0.001). The median morphine consumption during the first 24 postoperative hours was less in Groups 1 and 2 than in Group 3 (P < 0.001). There was no significant difference in analgesic consumption between Group 1 and Group 2. The median satisfaction score was higher in Group 1 compared with Groups 2 (P < 0.05) and 3 (P < 0.001).
  
  
  CONCLUSIONS
  A combination of intraarticular ropivacaine, morphine, and ketorolac followed by intermittent injections of ropivacaine as needed provided better pain relief, less morphine consumption, and improved patient satisfaction compared with the control group. The group that received IV ketorolac consumed less morphine and was more satisfied with treatment than patients in the control group.
authors.affiliation: Division of Anesthesiology and Intensive Care and Division of Orthopedics, Department of Medicine, Orebro University Hospital, Orebro, Sweden. kjell.axelsson@orebroll.se
authors.forename: Kjell
authors.initials: K
authors.lastname: Axelsson
authors.forename: Anil
authors.initials: A
authors.lastname: Gupta
authors.forename: Eva
authors.initials: E
authors.lastname: Johanzon
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Berg
authors.forename: Gustav
authors.initials: G
authors.lastname: Ekbäck
authors.forename: Narinder
authors.initials: N
authors.lastname: Rawal
authors.forename: Peter
authors.initials: P
authors.lastname: Enström
authors.forename: Ulf
authors.initials: U
authors.lastname: Nordensson
mesh_terms: D000328:Adult; D000577:Amides / Q000008:administration & dosage*; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D007270:Injections, Intra-Articular; D007275:Injections, Intravenous; D020910:Ketorolac / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D012107:Research Design; D000077212:Ropivacaine; D012782:Shoulder / Q000601:surgery*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D016861:Cyclooxygenase Inhibitors; D009020:Morphine; D000077212:Ropivacaine; D020910:Ketorolac