title: Postoperative analgesia for arthroscopic rotator cuff surgery: a comparison between subacromial and interscalene levobupivacaine.
abstract: OBJECTIVE
  Arthroscopic rotator cuff surgery can result in severe postoperative pain. We compared a continuous subacromial infusion to a continuous interscalene block with levobupivacaine for patients undergoing arthroscopic rotator cuff surgery.
  
  
  METHODS
  Sixty patients were randomized to two groups: 1) interscalene block with 0.5% levobupivacaine (30 mL) followed by a postoperative subacromial infusion: 0.125% levobupivacaine 5 mL/h basal infusion, 5 mL bolus dose and a 20 min lockout time or; 2) interscalene block with 0.5% levobupivacaine (30 mL) followed by a postoperative interscalene infusion: 0.125% levobupivacaine 5 mL/h basal infusion, 5 mL bolus dose and a 20 min lockout time. Infusions were maintained for 48 hours.
  
  
  RESULTS
  The VAS scores in the postanesthesia care unit and at 4 h were not different. The VAS scores at 8, 12, 24, 36 and 48 h were lower than 4 in both groups; but they were significantly lower in the interscalene group. Additional analgesic requirements were lower in the interscalene group (16.6% vs 53.3%, p<0.05). Patients' satisfaction was higher in the interscalene group (9.4±0.8 vs 8±1.2, p<0.01). One patient had a toxicity related to interscalene block but; there was no complication related to subacromial catheters.
  
  
  CONCLUSIONS
  This study demonstrates that subacromial infusions, although provided good postoperative analgesia, are not as effective as interscalene infusions and additional analgesics should be prescribed when subacromial infusions are started. Subacromial infusions could be considered as an alternative in case of any contraindication to interscalene block.
authors.affiliation: Department of Anesthesiology, İstanbul University, İstanbul Faculty of Medicine, Turkey. ahmetkoltka@yahoo.com
authors.forename: Kemalettin
authors.initials: K
authors.lastname: Koltka
authors.forename: Behiye
authors.initials: B
authors.lastname: Doğruel
authors.forename: Mert
authors.initials: M
authors.lastname: Sentürk
authors.forename: Ata Can
authors.initials: AC
authors.lastname: Atalar
authors.forename: Süleyman
authors.initials: S
authors.lastname: Küçükay
authors.forename: Kamil
authors.initials: K
authors.lastname: Pembeci
mesh_terms: D000328:Adult; D000698:Analgesia / Q000379:methods*; D015360:Analgesia, Epidural / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001182:Arthroscopy; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D017006:Rotator Cuff / Q000601:surgery*; D012782:Shoulder
chemical_list: D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine