title: Randomized, controlled trial of multimodal shoulder injection or intravenous patient-controlled analgesia after arthroscopic rotator cuff repair.
abstract: OBJECTIVE
  The aim of this study was to compare the effect of postoperative pain control and adverse effects of intravenous patient-controlled analgesia (IV PCA) and multimodal shoulder injection after arthroscopic rotator cuff repair.
  
  
  METHODS
  Seventy patients scheduled for elective arthroscopic rotator cuff repair were prospectively randomized to receive either IV PCA or multimodal shoulder injections. Postoperative pain, nausea, vomiting, and other adverse effects were assessed at 2, 6, 12, 24, and 48 h after surgery. Use of rescue analgesics and antiemetics, level of satisfaction, and cost for both modalities were recorded.
  
  
  RESULTS
  Pain was better controlled in the multimodal shoulder injection group at 2 h postoperatively (P = 0.001). However, the use of additional analgesics was greater in the multimodal shoulder injection group during 12-48 h after surgery (P < 0.001). The incidence of nausea within 12-24 h after surgery in the multimodal shoulder injection group (5.7 %) was less significant compared with that in the IV PCA group (31.4 %, P = 0.012), but no difference in overall incidence of the use of rescue antiemetics was observed between the groups (n.s.). No differences in adverse effects were noted between the groups. Patient satisfaction also showed no differences (n.s.). Costs required for both modalities were $20.3 for the multimodal shoulder injection and $157.8 for the IV PCA.
  
  
  CONCLUSIONS
  Multimodal shoulder injection is a safe and effective modality for management of pain after arthroscopic rotator cuff repair. Considering the expense and need of special devices for IV PCA, multimodal shoulder injection may be an effective and safe alternative to IV PCA for postoperative analgesia after arthroscopic rotator cuff repair.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea, hss9438@empal.com.
authors.forename: Sun Sook
authors.initials: SS
authors.lastname: Han
authors.forename: Ye Hyun
authors.initials: YH
authors.lastname: Lee
authors.forename: Joo Han
authors.initials: JH
authors.lastname: Oh
authors.forename: Susan
authors.initials: S
authors.lastname: Aminzai
authors.forename: Sae Hoon
authors.initials: SH
authors.lastname: Kim
mesh_terms: D016058:Analgesia, Patient-Controlled / Q000009:adverse effects; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy; D011446:Prospective Studies; D017006:Rotator Cuff / Q000601:surgery*; D016896:Treatment Outcome