The Efficacy of Continuous Intrabursal Infusion With Morphine And Bupivacaine for Postoperative Analgesia After Subacromial Arthroscopy

Park, Jin‐Young; Gwanwoo, Lee; Kim, Yun; Yoo, Moon-Jib

doi:10.1097/00115550-200203000-00006

Cited by 53 publications

(23 citation statements)

References 19 publications

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“…There is a risk that the catheter can become dislodged, which happened in one patient in our study, and has also been reported by others (20–24). Better methods need to be explored in order to retain the catheter firmly in position while allowing for easy removal .…”

Section: Discussionsupporting

confidence: 85%

“…Although saline infusion provided a statistically significant reduction in pain intensity, the effect was mild and of limited clinical importance. In a study where continuous intrabursal infusion of bupivacaine 2.5 mg h −1 combined with morphine was compared with saline postoperatively after subacromial arthroscopy (22), no difference was reported in pain caused by movement. In our study a 10‐ml infusion of ropivacaine 5 mg ml −1 on movement resulted in significantly lower pain scores than saline on movement ( P < 0.001).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Patient‐controlled regional analgesia (PCRA) with ropivacaine after arthroscopic subacromial decompression†

Axelsson

Nordenson

Johanzon

et al. 2003

Acta Anaesthesiol Scand

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Patient‐controlled regional analgesia (PCRA) with ropivacaine after arthroscopic subacromial decompression†

Axelsson

Nordenson

Johanzon

et al. 2003

Acta Anaesthesiol Scand

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“…There are few mentions of overall failure rate in the use of subacromial infusion pumps in previous reports, as the focus has been on efficacy. Similar technical failure rate, 5%, was observed in the study comparing continuous intrabursal local anesthetic infusion . In a study evaluating the efficacy of interscalene block and continuous subacromial infusion, there were six dropouts because of premature pump removal and one pump failure leading to seven dropouts from 92 study patients who got either single interscalene block or block with continuous infusion into subacromial space or only continuous infusion into subacromial space .…”

Section: Discussionsupporting

confidence: 64%

The analgesic effect of continuous subacromial bupivacaine infusion after arthroscopic shoulder surgery: a randomized controlled trial

Merivirta

Kuusniemi

Aantaa

et al. 2012

Acta Anaesthesiol Scand

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Background:The benefits of subacromial local anesthetic infusion are controversial. The aim of this study was to evaluate the efficacy of subacromial bupivacaine infusion after arthroscopic acromionplasty and rotator cuff procedures. Methods: Ninety patients with subacromial impingement disease scheduled for elective shoulder arthroscopy were enrolled in this randomized, prospective and placebo-controlled study. The patients received subacromially either 5.0 mg/ml bupivacaine or 9.0 mg/ml saline at the rate of 2 ml/h postoperatively for 48 h. The primary outcome measure was the use of rescue oxycodone. The consumption of opioids, ibuprofen, paracetamol and codeine, and the intensity of pain were recorded. Results: Patients receiving bupivacaine infusion used significantly less oxycodone compared with patients receiving saline [15 vs. 20 mg (median) oxycodone intravenously on the day of surgery, 0 vs. 10 mg (median) perorally on the first postoperative day]. There was no significant difference in the use of ibuprofen, paracetamol and codeine, except that paracetamol was used more in patients receiving saline during the day of surgery (P = 0.009). The pain scores of patients receiving bupivacaine were lower at 18 h (P = 0.008). Average pain scores for the worst pain experienced did not differ between the groups. There were three (4%) premature discontinuations because of technical problems. Conclusions: Considering the low need of opioids, expenses and technical problems in these patients, subacromial 5.0 mg/ml bupivacaine infusion 2 ml/h confers only moderate and probably clinically insignificant efficacy compared with placebo. This efficacy might be overweighed by the disadvantages.

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“…As effective pain relief is a paramount post‐surgical concern, alternative types and classes of compounds are being investigated for orthopedic surgical procedures performed on major joints such as the shoulder and knee. Pain management strategies have evolved to include longer‐acting regional blocks and direct intra‐articular administration of analgesics, which both have proven to be effective . Unfortunately, when delivered intra‐articularly, bupivacaine and other amino amides negatively affect articular cartilage as documented in clinical case series, animal models, and in vitro studies .…”

mentioning

confidence: 99%

Effect of highly purified capsaicin on articular cartilage and rotator cuff tendon healing: An in vivo rabbit study

Friel

McNickle

DeFranco

et al. 2015

Journal Orthopaedic Research

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Highly purified capsaicin has emerged as a promising injectable compound capable of providing sustained pain relief following a single localized treatment during orthopedic surgical procedures. To further assess its reliability for clinical use, the potential effect of highly purified capsaicin on articular cartilage metabolism as well as tendon structure and function warrants clarification. In the current study, rabbits received unilateral supraspinatus transection and repair with a single 1 ml injection of capsaicin (R þ C), PEG-only placebo (R þ P), or saline (R þ S) into the glenohumeral joint (GHJ). An additional group received 1 ml capsaicin onto an intact rotator cuff (I þ C). At 18 weeks post-op, cartilage proteoglycan (PG) synthesis and content as well as cell viability were similar (p > 0.05) across treatment groups. Biomechanical testing revealed no differences (p > 0.05) among tendon repair treatment groups. Similarly, histologic features of both cartilage and repaired tendons showed minimal differences across groups. Hence, in this rabbit model, a single injection of highly purified capsaicin into the GHJ does not induce a deleterious response with regard to cartilage matrix metabolism and cell viability, or rotator cuff healing. These data provide further evidence supporting the use of injectable, highly purified capsaicin as a safe alternative for management of postoperative pain following GHJ surgery.

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The Efficacy of Continuous Intrabursal Infusion With Morphine And Bupivacaine for Postoperative Analgesia After Subacromial Arthroscopy

Cited by 53 publications

References 19 publications

Patient‐controlled regional analgesia (PCRA) with ropivacaine after arthroscopic subacromial decompression†

Patient‐controlled regional analgesia (PCRA) with ropivacaine after arthroscopic subacromial decompression†

The analgesic effect of continuous subacromial bupivacaine infusion after arthroscopic shoulder surgery: a randomized controlled trial

Effect of highly purified capsaicin on articular cartilage and rotator cuff tendon healing: An in vivo rabbit study

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