Acta Ortopédica Mexicana

Orbezo FG, Trueba C, Huerta C, Lozano PJ, Pozzo A
Preventive analgesia in arthroscopic surgery of the shoulder joint
Acta Ortop Mex 2002; 16 (3)

Language: Español
References: 18
Page: 131-134
PDF: 35.79 Kb.

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Objective. This procedure has the objective to avoid the usual intense postoperative pain that appears after arthroscopic surgery in shoulder, which occurs in some 45% of the cases. Material and methods. This prospective trial was carried out in 20 patients, from January 2000 through June 2001 who were submitted to arthroscopic surgery because of either subachromial impingement, bicipital tendinitis, subachromial bursitis or partial supraspinatus tears; only performed procedures were subachromial debridement or achromioplasty; those cases with complete tears of supraspinatus were excluded. General anesthesia was conducted by 2 mg/kg of propofol, 1 mg/kg of lydocaine, 5 mg/kg of atracurium and 2 µg/kg of fenthanyl and no specific analgesic was used in the transoperative period. Patients were classified in 2 groups for comparison of postoperative pain: those from the study group who were administered with 375 mg of ropivacaine and 100 µg of fenthanyl, in a mixture of 20 ml; first 10 ml were instilled inside the joint 10 minutes before arthroscopy and the remaining 10 ml at the end of the procedure. Those patients from the second or control group were not given intra-articular anesthesia. Postoperative analgesia was assessed according to an analogue visual scale of 4 points at 1, 2, 4 and 12 hours after surgery. Results. Postoperative analgesia was present in all the first group patients from 2 to 6 hours, with no need for extra specific analgesics. Patients from the control group referred pain immediately after waking-up from anesthesia and intravenous 30 mg of kethorolac twice was required to control pain; in the following 30 minutes, an additional dose of 100 mg of intravenous kethoprofen was needed in 6 cases (p=0.01). No transoperative bleeding or other postoperative complications occurred in anyone of all 20 patients. Conclusion. Preventive postoperative analgesia is a safe and effective method for handling immediate postoperative pain. The most important observation is the subjective comfortable reaction of patients, who do not complained about pain in the first hours, which are considered critical for all people.

Key words: shoulder, joint, anesthesia intra-articular, arthroscopy, postoperative.


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