Patient-Controlled Analgesia Using Accufuser-plus kit(R) after Arthroscopic Rotator CuffRepair: Subacromial Catheter vs Intravenous Injection

Rhee, Yong Girl; Ha, Jeong Han; Cho, Nam Su; Jeong, Bi O

Abstract

PURPOSE: To compare the efficacy of a patient-controlled subacromial with intravenous analgesia following arthroscopic rotator cuff repair.
MATERIALS AND METHODS
In this prospective study, 40 cases of arthroscopic rotator cuff repair who received patient-controlled analgesia by Accufuser-plus kit(R) were analyzed. There were 21 men and 19 women with a mean age of 54 years (range, 33 to 73). The patients were divided into two groups, one (20 cases in each) receiving subacromial infusion with 0.5% bupivacaine and the other receiving an intravenous infusion with fentanyl and ketorolac tromethamine. A visual analog scale (VAS) was used to record the patient's level of pain every 12 hours until the first 72 hours after surgery, and for 48 hours after the patient-controlled analgesia was stopped.
RESULTS
The mean preoperative VAS during motion was 6.8 in the subacromial infusion group and 5.8 in the intravenous infusion group. The immediate postoperative VAS was 7.6 and 7.4. The subacromial infusion showed significantly better results than the intravenous infusion in 24 hours, 48 hours at rest and 48 hours during motion. After the patient-controlled analgesia was stopped, the VAS increased for the first 12 hours but decreased thereafter. Acromioplasty did not affect the results and the number of supplemental analgesic injections during patient-controlled analgesia was similar in the two groups. Three cases in the intravenous infusion group gave up the patient-controlled analgesia due to transient hypotension, nausea and vomiting.
CONCLUSION
Patient-controlled analgesia using Accufuser-plus kit(R) after an arthroscopic rotator cuff repair showed that a subacromial infusion is a faster and more effective method of decreasing the level of postoperative pain than an intravenous infusion with less complications.