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Korean Journal of Anesthesiology 2007;53(1):72-78.
DOI: https://doi.org/10.4097/kjae.2007.53.1.72   
Comparison of Intra-articular versus Intra-venous Patient Controlled Analgesia (PCA) following Arthroscopic Shoulder Surgery.
Kyung Sil Im, Yong Soon Kwon, Hyun Ju Jung, Jae Myeong Lee, Jong Bun Kim, Kuhn Park, Jin Cheol Sim, Oh Soo Kwon
1Departments of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea. jbkim@catholic.ac.kr
2Departments of Orthopedic Surgery, College of Medicine, The Catholic University of Korea.
3Department of Obstetrics and Gynecology, Asan Medical center, College of Medicine, University of Ulsan, Seoul, Korea.
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.
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.
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.
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.
Key Words: analgesia; arthroscopic shoulder surgery; bupivacaine; morphine


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