Patient-controlled interscalene analgesia versus patient-controlled intravenous analgesia in postoperative analgesia after upper extremity surgery

Abstract

The effectiveness of patient-controlled interscalene analgesia (PCISA) and patient-controlled intravenous analgesia (PCIVA) in the management of postoperative pain in 36 patients was studied. The general anesthetic technique was standardized. After surgery, all patients received 2 mg intravenous morphine. The patients were then randomized to receive either PCISA or PCIVA. The PCISA group received an interscalene block with 20 ml of 1% lidocaine. A catheter was introduced within the interscalene sheath and 20 min after the initial block, patients received a continuous infusion of 0.125 bupivacaine at rate of 4 ml/h supplemented by a bolus dose of 3 ml with a 15-min lockout time. PCIVA was given as a 1 mg morphine bolus and a 7-min lockout time. Pain relief was regularly assessed using a visual analog scale. Side effects and patient satisfaction were noted. The study period ended 48 h after the operation. Pain relief was significantly better controlled in the PCISA group 6, 12, 24, and 30 h after the operation (P<0.05). At 36, 42, and 48 h, no significant difference in pain score between the two groups was observed. Patient satisfaction was greater in the PCISA group (P<0.05). Vomiting and pruritus were observed more frequently in the PCIVA group (P<0.05). No major complications occurred in any of the study patients. The use of the PCISA technique was uncomplicated and provided better pain relief than PCIVA in postoperative analgesia.