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


CONCLUSIONS
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.
Cho
Chul-Hyun
CH
Department of Orthopedic Surgery, Pain Research Center, Dongsan Medical Center, School of Medicine, Keimyung University, 194 Dongsan-Dong, Joong-Gu, Daegu, 700-712, Korea. oscho5362@dsmc.or.kr
Song
Kwang-Soon
KS
Min
Byung-Woo
BW
Lee
Kyung-Jae
KJ
Ha
Eunyoung
E
Lee
Yong-Chul
YC
Lee
Young-Kuk
YK
D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000627:therapeutic use*; D001182:Arthroscopy; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D020910:Ketorolac / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017294:Ondansetron / Q000627:therapeutic use; D010098:Oxycodone / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D014147:Tramadol / Q000627:therapeutic use; D016896:Treatment Outcome
D000700:Analgesics; D052246:Cyclooxygenase 2 Inhibitors; D000082:Acetaminophen; D014147:Tramadol; D017294:Ondansetron; D010098:Oxycodone; D005283:Fentanyl; D020910:Ketorolac