Comparison of Intra-articular versus Intra-venous Patient Controlled Analgesia (PCA) following Arthroscopic Shoulder Surgery.
10.4097/kjae.2007.53.1.72
- Author:
Kyung Sil IM
1
;
Yong Soon KWON
;
Hyun Ju JUNG
;
Jae Myeong LEE
;
Jong Bun KIM
;
Kuhn PARK
;
Jin Cheol SIM
;
Oh Soo KWON
Author Information
1. Departments of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea. jbkim@catholic.ac.kr
- Publication Type:Original Article ; Randomized Controlled Trial
- Keywords:
analgesia;
arthroscopic shoulder surgery;
bupivacaine;
morphine
- MeSH:
Analgesia;
Analgesia, Patient-Controlled*;
Anesthesia, General;
Bupivacaine;
Catheters;
Dizziness;
Humans;
Injections, Intra-Articular;
Morphine;
Ondansetron;
Passive Cutaneous Anaphylaxis;
Range of Motion, Articular;
Shoulder*
- From:Korean Journal of Anesthesiology
2007;53(1):72-78
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: The purpose of this study was to compare the postoperative analgesic effects and side effects of an intra-articular PCA infusion of bupivacaine and morphine using an intravenous PCA infusion of morphine following arthroscopic shoulder surgery. METHODS: Seventy-one patients, undergoing arthroscopic shoulder surgery under general anesthesia, were randomly assigned to one of two groups. In group 1 (n = 32), morphine and ondansetron, 8 and 4 mg, respectively, were intravenously injected following surgery, with the subsequent infusion of normal saline 100 ml, including morphine and ondansetron, 32 and 12 mg, respectively, through an intra-venous PCA catheter. In group 2 (n = 39), 0.25% bupivacaine, 40 ml, including an intra-articular injection of morphine, 3 mg, followed by an infusion of 0.25% bupivacaine, 100 ml, including morphine, 5 mg, were administered through an intra-articular PCA catheter. In groups 1 and 2, the PCA infusion rate was 2 ml/h, with a bolus dose of 0.5 ml, with a lock out time of 8 min. The VAS for pain at rest, and the range of motion (ROM) exercise and side effects were assessed 0.5, 1, 2, 4, 12, 18 and 24 h postoperatively. RESULTS: The patients in group 2 had significantly lower VAS for pain for the ROM than those in group 1 30 min postoperatively. However, the VAS for pain at rest was significantly lower in group 1 than 2 after 18 and 24 h, but the VAS for pain for the ROM was significantly lower in group 1 than 2 24 h postoperatively. There was no significant difference in the side effects between the two groups, with the exception of dizziness, which was more severe in group 2 at 1, 2 and 4 h postoperatively. CONCLUSIONS: An intra-articular PCA infusion of bupivacaine and morphine is no more effective than an intra-venous PCA infusion of morphine and ondansetron with respect to postoperative analgesia and side effects.
