Subacromial patient-controlled analgesia with ropivacaine provides effective pain control after arthroscopic rotator cuff repair.
OBJECTIVE
To investigate the postoperative analgesic effect of subacromial patient-controlled analgesia (SA-PCA) with ropivacaine in comparison with intravenous patient-controlled analgesia (IV-PCA) after arthroscopic rotator cuff repair.


METHODS
Sixty patients were prospectively randomized into one of the two types of analgesics for 48 h after the operation. In the SA-PCA group, patients received 0.5% ropivacaine at a rate of 2 ml/h with a patient-controlled bolus dose of 2 ml. In the IV-PCA group, patients received intravenous patient-controlled analgesia. Pain relief was regularly assessed using visual analog scale (VAS) for 48 h, and side effects were noted.


RESULTS
The postoperative pain VAS at 1 h after the operation was lower for the SA-PCA group (4.3 ± 2.7) than for the IV-PCA group (6.3 ± 2.6, P = 0.009). The frequency of requested bolus doses by patients in the IV-PCA (19 ± 19) was higher than in the SA-PCA (7 ± 10, P = 0.04). Rescue opioid or NSAID requirements were not different. More patients in the IV-PCA (17/30) experienced nausea than in the SA-PCA (7/30, P = 0.03). Patient satisfaction was higher in the SA-PCA than in the IV-PCA [6.7 (3-10) vs. 5.6 (0-8), P = 0.04]. The mean total venous plasma concentration of ropivacaine at 8 and 24 h was below the maximum tolerated venous plasma concentration, and symptoms of systemic toxicity were not noted during 48 h in the SA-PCA.


CONCLUSIONS
The analgesic effect of subacromial patient-controlled analgesia with ropivacaine was better than intravenous analgesia during the immediate postoperative period with fewer side effects.


METHODS
Therapeutic study, Level I.
Department of Anesthesiology and Pain Medicine, National Medical Center, 243 Euljiro, Jung-gu, Seoul, Korea.
Mi Ja
MJ
Yun
Joo Han
JH
Oh
Jong Pil
JP
Yoon
Sang Hyun
SH
Park
Jung Won
JW
Hwang
Ho Young
HY
Kil
D000174:Acromion; D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage* / Q000627:therapeutic use; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000627:therapeutic use; D001182:Arthroscopy; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011446:Prospective Studies; D000077212:Ropivacaine; D017006:Rotator Cuff / Q000601:surgery; D000070636:Rotator Cuff Injuries; D013708:Tendon Injuries / Q000601:surgery*; D016896:Treatment Outcome
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine