A comparison of patient-controlled subacromial and i.v. analgesia after open acromioplasty surgery

Abstract

The aim of this study was to compare three patient-controlled analgesia (PCA) techniques for pain relief after acromioplasty. These techniques included use of subacromial ropivacaine, subacromial fentanyl or i.v. fentanyl. Forty-eight patients scheduled for open acromioplasty surgery were prospectively randomized to receive ropivacaine 0.2% (Group R) or fentanyl 4 microg ml(-1) (Group F) for subacromial analgesia, or fentanyl 4 microg ml(-1) (Group C) for i.v. analgesia. All patients received background infusion at a rate of 5 ml h(-1) plus a PCA bolus dose of 3 ml with a lockout time of 20 min. In addition, rescue analgesia with tramadol 50-100 mg i.v. was available on demand. Pain relief was regularly assessed using a visual analogue scale (0-10 cm) and side-effects were noted. The postoperative pain scores at 2, 4, 6 and 12 h after the start of PCA were higher in Group F compared with Group R and Group C (P<0.001), However, the pain scores at the other time points were similar between the three groups. Pain scores, incremental dose requested and received, total volume of analgesic solution infused and rescue tramadol were similar between Group R and Group C. Specific side-effects were similar in the three groups. The PCA techniques using subacromial ropivacaine or fentanyl i.v. provided similar and adequate pain relief and minimal side-effects after open acromioplasty surgery. The PCA using subacromial fentanyl was not as effective as either subacromial ropivacaine or i.v. fentanyl.