title: Efficacy of multimodal analgesia injection combined with corticosteroids after arthroscopic rotator cuff repair.
abstract: BACKGROUND
  Although arthroscopic rotator cuff repair is minimally invasive, there is still considerable postoperative pain, especially during the first 48 hours. The present study assessed the short-term efficacy and safety of multimodal analgesic (MMA) injection associated to corticosteroids in arthroscopic rotator cuff tear surgery.
  
  
  METHODS
  A single-center prospective randomized study included 50 patients undergoing arthroscopic rotator cuff tear surgery. The study group received subacromial injection of a mixture of morphine, ropivacaine and methylprednisolone associated to intra-articular injection of morphine plus methylprednisolone; the control group received only isotonic saline. All patients had had 24 hours self-administered morphine associated to standard analgesia. Postoperative data were recorded at 30 minutes and 1, 2, 4, 6, 12, 18 and 24 hours: pain intensity, morphine intake and side effects, and also time to first morphine bolus and additional analgesic intake. Constant, ASES and SST functional scores were recorded at 3 months.
  
  
  RESULTS
  Postoperative pain was significantly less intense in the MMA group than in controls at 30 min, H1, H4, H6, H12, H18 and H24 (P<0.05). A rebound at D10 occurred in both groups. During the first 24 hours, MMA significantly reduced cumulative resort to morphine (P<0.05 at H1/2, P<0.001 at H1-24). Mean time to first bolus was significantly longer in the MMA group (71.6 vs. 33 min; P<0.05). The rate of opioid-related side effects was similar between groups. At last follow-up, functional scores were similar between groups. There were no cases of infection or delayed skin healing.
  
  
  CONCLUSIONS
  MMA associated to corticosteroids after arthroscopic rotator cuff tear surgery provided immediate benefit in terms of analgesia and morphine sparing, without apparent risk of infection. The practice is presently little known in France and deserves longer-term assessment, especially as regards functional rehabilitation and tendon healing.
  
  
  METHODS
  2.
authors.affiliation: Service de chirurgie orthopédique et traumatologique, Centre hospitalier régional de Liège, 1, boulevard du 12(e)-de-la-Ligne, 4000 Liège, Belgium. Electronic address: perdreaua@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Perdreau
authors.affiliation: Clinique chirurgicale du Libournais, 119, rue de la Marne, 33500 Libourne, France.
authors.forename: T
authors.initials: T
authors.lastname: Joudet
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000368:Aged; D000577:Amides / Q000008:administration & dosage; D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001182:Arthroscopy / Q000009:adverse effects*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D000077212:Ropivacaine; D017006:Rotator Cuff / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D009020:Morphine; D000077212:Ropivacaine; D008775:Methylprednisolone
keywords: Arthroscopy; Corticosteroids; Multimodal analgesia; Postoperative pain; Rotator cuff repair