Management of pain after the rotator cuff arthroscopic suture: comparative study among the interescalenic blockade and the continuous intrabursal infusion

Alexandre Almeida Gilberto Roveda Márcio Rangel Valin Maria Cristina Sommer Valin Nayvaldo Couto de Almeida Ana Paula Agostini About the authors

OBJECTIVE: To compare the level of postoperative pain in patients submitted to arthroscopic suture of a rotator cuff lesion who had different analgesia protocols. To demonstrate the relationship between pain and the gender of the patient, the dimension of the lesion sutured, and the use of internal capsulotomy. To check the prevalence of side effects. METHODS: Three groups of patients operated on between June 01, 2004 and May 31, 2007 were analyzed. Group I comprised patients who received interescalenic blockade with 0.75% ropivacaine. In group II, the same blockade was added with 150 µg of clonidine. In group III, a 30 ml bolus of 0.75% ropivacaine was administered to infiltrate the arthroscopic portals and directly in the subacromial space, followed by a continuous infusion of 0.2% ropivacaine with an infusion pump. The patients were submitted to the medication of the EAV analogue-visual scale 24 hours after the procedure. The variables studied were EAV, gender, size of the lesion, need of internal capsulotomy, and prevalence of side effects. The study evaluated 196 patients, 51 of whom were excluded, thus giving a total " n" = 145 patients. The total of patients in group I was 65, in group II, 19, and in group III, 61. RESULTS: The mean EAV index found for group I was 3.88 ± 1,737 (3); in group II, it was 3.8 ± 1.6 (3), and in group III, 1.95 ± 1.6 (2). There was a significant difference when comparing group I to group III (p < 0.001) and when comparing group II to group III (p < 0.001) suggesting less pain felt by patients in group III. There was no pain perception difference between genders (p = 0.700) and among the different sizes of rotator cuff lesion (p = 0.546). There was a pain perception difference between patients that were and those that were not submitted to internal capsulotomy (p = 0.038). There was reduced prevalence of nausea and/or vomiting (p = 0.089) and of pruritus (p = 0.092) in group III as compared to groups I and II. CONCLUSIONS: The protocol of postoperative analgesia with continuous infusion of ropivacaine showed that it is better than the protocols using morphine after the end of the interescalenic blockade effects. There was no difference in pain perception between the genders and according to different sizes of sutured lesions. There was a difference in pain perception by the patients who had and those who have not had internal capsulotomy. The rate of side effects was similar among the analgesia protocols.

Rotator cuff; Arthroscopy; Analgesia; Pain measurement; Prospective studies; Comparative study

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