16. PAIN MANAGEMENT AFTER ARTHROSCOPIC ROTATOR CUFF REPAIR: PROSPECTIVE RANDOMISED STUDY OF 140 CASES COMPARING THREE ANTI-PAIN TECHNIQUES

Abstract

Purpose of the study: Arthroscopic repair of rotator cuff tears is a painful technique. We conducted a randomized controlled trial to analyze prospectively the level of postoperative pain after this procedure and to assess the efficacy of three anti-pain techniques.

Material and method: This prospective randomized study included 140 patients attending two centres specialized in shoulder surgery who underwent arthroscopic rotator cuff repair from January to November 2008. Preoperatively, patients were assigned to three anti-pain techniques: interscalenic catheter (KTIS) (n=44 patients), subacromial catheter (KTSA) (n=64 patients), unique subacromial injection of 2% ropivacaine (INJ) (n=32 patients). The procedure was performed under general anaesthesia in all cases. Criteria used to evaluate the efficacy of the anti-pain techniques were: pain as assessed by a visual analogue scale (VAS) the day before operation to the 30th postoperative day; daily consumption and total dose of opiates; subjective satisfaction with pain management assessed on day 30.

Results: The pain profile was the same as demonstrated last year with a painful displacement on day 1 and progressive decline in pain through day 30 when the pain level was lower than preoperatively. Two risk factors were noted: isolated distal tears of the supraspinatus and concomitant acromioplasty. On day 0, the VAS was ≤ 1.7 in the KTIS group versus 3.6 and 3.5 respectively in the KTSA and INJ groups (p< 0.05). On day 1, the respective values were 3.1, 3.5 and 3.8 (NS). On day 2 and beyond, there was no difference between the three groups. Overall morphine consumption on day 0 was 10.8 mg in the INJ group versus 6.9 and 2.1 mg in the KTSA and KTIS groups, with a significant difference between the INJ and the KTIS groups. There was no difference beyond day 1. Patient satisfaction with pain management during the first 30 postoperative days reached 94.4, 82.9 and 84% respectively for INJ, KTIS and KTSA, with no statistically significant difference between the groups.

Conclusion: The interscalenic catheter technique is more effective than the two other techniques. The subacromial catheter is not better than a single injection of local anaesthetic and is associated with greater risk, suggesting its use should be revisited.