Subacromial patient-controlled analgesia with ropivacaine provides effective pain control after arthroscopic rotator cuff repair

Purpose

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.

Level of evidence

Therapeutic study, Level I.