Postoperative Analgesia for Arthroscopic Rotator Cuff Surgery: A Comparison Between Subacromial and Interscalene Levobupivacaine

Kemalettin Koltka1, Behiye Doğruel1, Mert Şentürk1, Ata Can Atalar2, Süleyman Küçükay1, Kamil Pembeci1

1Department Of Anesthesiology, Istanbul University, Istanbul Faculty Of Medicine, Istanbul, Turkey
2Department Of Orthopedics And Traumatology, Istanbul University, Istanbul Faculty Of Medicine, Istanbul, Turkey

Keywords: arthroscopic rotator cuff surgery, postoperative analgesia, interscalene catheter, subacromial catheter, levobupivacaine

Abstract

Introduction: Arthroscopic rotator cuff surgery can result in severe postoperative pain. We compared a continuous subacromial infusion to a continuous interscalene block with levobupivacaine for patients undergoing arthroscopic rotator cuff surgery.
Methods: Sixty patients were randomized to two groups: 1) interscalene block with 0.5% levobupivacaine (30 mL) followed by a postoperative subacromial infusion: 0.125% levobupivacaine 5 mL/h basal infusion, 5mL bolus dose and a 20 min lockout time or; 2) interscalene block with 0.5% levobupivacaine (30 mL) followed by a postoperative interscalene infusion: 0.125% levobupivacaine 5 mL/h basal infusion, 5mL bolus dose and a 20 min lockout time. Infusions were maintained for 48 hours.
Results: The VAS scores in the postanesthesia care unit and at 4 h were not different. The VAS scores at 8, 12, 24, 36 and 48 h were lower than 4 in both groups; but they were significantly lower in the interscalene group. Additional analgesic requirements were lower in the interscalene group (16.6% vs 53.3%, p<0.05). Patients’ satisfaction was higher in the interscalene group (9,4 ± 0,8 vs 8 ± 1,2, p<0,01). One patient had a toxicity related to interscalene block but; there was no complication related to subacromial catheters.
Conclusions: This study demonstrates that subacromial infusions, although provided good postoperative analgesia, are not as effective as interscalene infusions and additional analgesics should be prescribed when subacromial infusions are started. Subacromial infusions could be considered as an alternative in case of any contraindication to interscalene block.