Evaluation of our patient-controlled analgesia protocols applied in orthopedi̇c surgery

Abstract

The patient-controlled analgesia (PCA) method is a crucial part of daily anesthesia practice, with different application methods to provide analgesia after orthopedic surgeries. This study aims to assess the effectiveness of intravenous (IV), interscalene, and subacromial PCA in managing postoperative pain in shoulder arthroscopy operations performed at our clinic. Follow-up forms of patients aged between 25 and 85 who were operated on and underwent PCA in the Istanbul Medical Faculty Orthopedics operating room were scanned. The patients who underwent shoulder arthroscopy were divided into three main groups (intravenous, interscalene, and subacromial) according to the PCA application method. Visual Analog Scale (VAS) values at rest and during movement, the presence of nausea and vomiting, and the need for additional analgesia were recorded. Of the 142 patients in whom PCA was used after shoulder arthroscopy, 40 had intravenous, 41 had interscalene, and 61 had subacromial PCA. The demographic characteristics (age, gender, and body mass index) of all three groups were statistically similar. When we look at the percentage of cases with a resting VAS value >3 in patients who underwent intravenous, interscalene, and subacromial PCA, it was found to be 25%, 0.0%, and 32.8%, respectively (p=0.005). The percentage of cases with a movement VAS value >3 was 80%, 12.2%, and 73.8% for the groups, respectively (p<0.001). Additional analgesia was required in 80% of intravenous PCA patients, 52.5% of subacromial PCA patients, and 7.3% of interscalene PCA patients (p<0.001). Vomiting complaints occurred in 50%, 2.4%, and 1.6% of intravenous, interscalene, and subacromial PCA, respectively (p<0.001). Using interscalene PCA instead of intravenous PCA significantly reduced the likelihood of a VAS score at movement of more than 3 and the need for additional analgesic administration (p<0.001). Postoperative pain control after arthroscopic shoulder surgery is important for the patient's comfort and recovery. Patient-controlled analgesia can be applied intravenously, subacromial, or interscalene to control postoperative pain in this patient group. However, interscalene PCA application is a more effective method than intravenous application in terms of both pain control and side effects.