title: [Quality of post-operative pain therapy after subacromial decompression of the shoulder with resection of the lateral clavicula by arthroscopy].
abstract: BACKGROUND
  Shoulder impingement is one of the most common orthopaedic arthropathies. A minimally invasive surgery is indicated in cases of persistent symptoms or non-responders to conservative pain therapy. Normally, strong postoperative pain of the shoulder requires an effective pain therapy.
  
  
  METHODS
  100 patients suffering from shoulder impingement with involvement of the acromioclavicular joint (55 male, 45 female, mean age 56, age range 37-78 years) were operated in 2007 and 2008 in the department of orthopaedics of the LVR-hospital. We aimed to evaluate the value of a subacromial pain catheter with ropivacaine (n = 33) compared to a conservative pain therapy ("Würzburger Schmerztropf"/tramadol, novaminsulfon and metroclopramid and "Hettinger Infusion"/tramadol, novaminsulfon, dimenhydrinate as needed) alone (n = 34) or with an additional intraoperative administration of a single dose of ropivacaine (n = 33) after arthroscopic subacromial decompression of the shoulder with resection of the lateral clavicula. Additionally, patients of all three groups received a baseline analgesia with cryotherapy and diclofenac.
  
  
  RESULTS
  Patients who received pain therapy by subacromial catheter reported less pain in the first 48 hours after surgery compared to ropivacaine intraoperatively and a standard pain therapy. Although all three methods achieved a significant pain reduction in the postoperative period, patients with subacromial catheter claimed the highest satisfaction with the therapy. Moreover, we could show that the subacromial pain catheter is a very efficient method with a high acceptance by the patients which is easy to perform and free of complications when considering the respective hygienic measures.
authors.affiliation: Orthopädie, Unfallchirurgie und Handchirurgie, Helios Klinikum Krefeld.
authors.forename: M A
authors.initials: MA
authors.lastname: Ferrando Fons
authors.affiliation: Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn.
authors.forename: L
authors.initials: L
authors.lastname: Maintz
authors.affiliation: Orthopädie, LVR Klinik für Orthopädie Viersen.
authors.forename: D P
authors.initials: DP
authors.lastname: König
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D000772:Anesthesia, Local; D001182:Arthroscopy / Q000379:methods*; D002408:Catheters, Indwelling; D002968:Clavicle / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011785:Quality Assurance, Health Care; D000077212:Ropivacaine; D019534:Shoulder Impingement Syndrome / Q000175:diagnosis / Q000601:surgery*
chemical_list: D000577:Amides; D000077212:Ropivacaine