Interscalene versus subacromial continuous infusion of ropivacaine after arthroscopic acromioplasty: a randomized controlled trial.
BACKGROUND
Interscalene and subacromial infusion of local anesthetics have both been shown to be effective in alleviating pain after shoulder arthroscopy. We performed a prospective randomized clinical trial in which both methods were compared in patients after acromioplasty.


METHODS
Forty patients received a subacromial (n = 20) or an interscalene (n = 20) continuous infusion of 2% ropivacaine (2 mL/h) after arthroscopic acromioplasty. Visual analog scale pain scores, additional medication requirements, and side effects were evaluated for 43 hours. The incidence of night pain was recorded.


RESULTS
Compared with the subacromial infusion, the continuous interscalene infusion of ropivacaine in the operated-on shoulder resulted in significantly reduced visual analog scale pain scores measured during rest, and also during exercise at 8 and 12 hours after surgery. The incidence of night pain was significantly lower in the interscalene group (P = .018).


CONCLUSIONS
A continuous subacromial infusion of 0.2% ropivacaine (2 mL/h) is inferior to continuous interscalene infusion, particularly during the first 12 hours, but could be an alternative in patients with contraindications of interscalene anesthesia or when acromioplasty is performed as an outpatient procedure.
Winkler
Tobias
T
Center of Musculoskeletal Surgery, Department of Orthopaedics, Charité-Universitätsmedizin Berlin, Berlin, Germany. tobias.winkler@charite.de
Suda
Arnold J
AJ
Dumitrescu
Radu V
RV
Pinggera
Oswald
O
Weber
Georg
G
Loho
Gerald
G
Schneider
Barbara
B
Wurnig
Christian
C
D000174:Acromion / Q000293:injuries / Q000601:surgery*; D000328:Adult; D000368:Aged; D000577:Amides / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000627:therapeutic use; D001182:Arthroscopy / Q000009:adverse effects* / Q000379:methods; D001917:Brachial Plexus / Q000187:drug effects; D005260:Female; D006801:Humans; D036502:Infusions, Intralesional; D007270:Injections, Intra-Articular; D008297:Male; D009407:Nerve Block / Q000379:methods*; D019637:Orthopedic Procedures / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology / Q000517:prevention & control*; D017060:Patient Satisfaction; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D000077212:Ropivacaine; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine