Monday, September 23, 2013

Lack of effectiveness of a subacromial pain pump infusion after arthroscopic cuff repair

Efficacy of continuous subacromial bupivacaine infusion for pain control after arthroscopic rotator cuff repair

While most surgeons are now aware of the dangers of the intra articular infusion of local anesthetics with a pain pump, some still advocate the use of pain pumps in the subacromial space after arthroscopic surgery.

These authors conducted a well done randomized controlled trial in 88 patients undergoing arthroscopic rotator cuff repair. Importantly, "the authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article."

The patients were randomized in a blinded fashion into 1 of 3 groups. Group 1 received no postoperative subacromial infusion catheter. Group 2 received a postoperative subacromial infusion catheter filled with saline solution. Group 3 received a postoperative subacromial infusion catheter filled with 0.5% bupivacaine without epinephrine. Infusion catheters were scheduled to infuse at 4 mL/h for 50 hours. They assessed postoperative pain levels  with visual analog scale scores hourly for the first 6 postoperative hours, every 6 hours for the next 2 days, and then every 12 hours for the next 3 days. Patients recorded daily oxycodone consumption for the first 5 postoperative days.

Immediately postoperative, the group with no catheter had significantly lower visual analog scale scores (P = .04). There were no significant differences in visual analog scale scores among the groups at any other time point. There were no differences found among the groups regarding mean daily oxycodone consumption.

They concluded that the use of continuous bupivacaine subacromial infusion catheters resulted in no detectable pain reduction after arthroscopic rotator cuff repair based on visual analog scale scores and narcotic medication consumption.

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