INTRA BURSAL PERFUSION WITH BUPIVACAINE AND FENTANYL AS A METHOD OF POSTOPERATIVE ANALGESIA FOLLOWING ELECTIVE SHOULDER SURGERY

Abstract

The aim of the study is to compare the postoperative pain relief provided by continuous perfusion of wound by bupivacaine and fentanyl with that of patient controlled analgesia using morphine in elective shoulder surgery. This retrospective case control study included 76 consecutive patients who had elective shoulder surgery. 39 patients had patient controlled analgesic system (PCA) with morphine and 37 patients had a continuous wound perfusion(intra bursal) with bupivacaine and fentanyl via a disposable Silicone Balloon Infuser. Patients were also given additional oral NSAIDs or morphine if needed. The pain score measured postoperatively based on a 10 point Visual Analogue Scale (VAS) at 1, 2, 3 and 18 hours was noted. The use of antiemetics and additional painkillers was recorded. The complications of both methods were also noted.

We found that the analgesia provided by continuous perfusion of wound by bupivacaine and fentanyl was constant and comparable to that provided by the patient controlled analgesic system using morphine. PCA with morphine was associated with significantly high incidence of nausea and vomiting (p < 0.001).We conclude that continuous perfusion of the wound by bupivacaine and fentanyl appears to be a simple, effective and safe method of providing analgesia following elective shoulder surgery.