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.