Analgesia after Subacromial Arthroscopic Surgery: Prospective Double-blind Study of Continuous Mixed Intra-bursal Infusion with Bupivacaine, Bupivacaine/Morphine, Bupivacaine/Fentanyl.

Sim,  Sung Eun; Park,  Jin Young; Kim,  Yong Chul; Yun,  Mi ja

doi:2004.46.3.323

Clinical Research Article

Korean Journal of Anesthesiology 2004;46(3):323-328.
DOI: https://doi.org/10.4097/kjae.2004.46.3.323

Analgesia after Subacromial Arthroscopic Surgery: Prospective Double-blind Study of Continuous Mixed Intra-bursal Infusion with Bupivacaine, Bupivacaine/Morphine, Bupivacaine/Fentanyl.

Sung Eun Sim, Jin Young Park, Yong Chul Kim, Mi ja Yun

¹Department of Anesthesiology and Pain Medicine, Seoul Municipal Boramae Hospital, Seoul, Korea.
²Department of Orthopedic Surgery, Dankook University, Cheonan, Korea.
³Department of Anesthesiology and Pain Medicine, Seoul National University, Seoul, Korea.
⁴Seoul National University Bundang Hospital, Sungnam, Korea.

Abstract

BACKGROUND
The purpose of this study was to compare the relative analgesic efficacies of the postoperative intra-bursal infusion of bupivacaine, bupivacaine/morphine, and bupivacaine/fentanyl after shoulder arthroscopy.
METHODS
At the end of subacromial arthroscopy, a continuous intra-bursal infusion catheter was inserted. A bolus dose was injected via the catheter just after the operation and a maintenance dose was infused for 4 days (1 ml/h). The bupivacaine group (Group B, n = 25), received 10 ml of 0.5% bupivacaine and 96 ml of 0.25% bupivacaine. The bupivacaine/morphine group (Group BM, n = 25) received 2 mg of morphine in 10 ml of 0.5% bupivacaine and 8 microgram of morphine in 96 ml of 0.25% bupivacaine. And the bupivacaine/fentanyl group (Group BF, n = 25) received 100 microgram of fentanyl in 10 ml of 0.5% bupivacaine and 400 microgram of fentanyl in 96 ml of 0.25% bupivacaine. VAS at rest and exercise were evaluated preoperatively and postoperatively for 3 days. The frequency of IM rescue analgesic were recorded.
RESULTS
We did not find any significant differences in VAS, or in need for rescue analgesic between the three groups. Resting pain score was significantly reduced at the 2 nd- and 3 rd postoperative day versus the preoperative value in Group B and BM, and at the 3 rd postoperative day in Group BF (P < 0.05). Pain score at exercise was reduced at the 3 rd postoperative day versus the preoperative value in all groups (P < 0.05).
CONCLUSIONS
The combination of morphine or fentanyl with bupivacaine did not provide better postoperative analgesia than bupivacaine after shoulder arthroscopy.

Key Words: analgesia; arthroscopy; bupivacaine; fentanyl; morphine; shoulder