Orbezo FG, Trueba C, Huerta C, Lozano PJ, Pozzo A

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

ABSTRACT

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.

REFERENCES

1. Barash P, Cullen B, Stoelting R. Anestesia clínica. McGraw-Hill Interamericana. Tercera Edición, Vol. II, 1999: 1216.

2. Canale T. Campbell Cirugía Ortopédica. Harcout Brace. Novena Edición. Vol. 2, 1998: 1563.

3. Gatt C, Ferrante C, Parker R. Pre-emptive analgesia in anterior cruciate ligament reconstruction. Sports Medicine and Arthroscopy Review. 1998; 6(3): 190-198.

4. Graham N, Shanahan M, Barry P, Bugert S, Talkhani I. Postoperative analgesia after arthroscopic knee surgery: A randomized, prospective, double-blind study of intravenous regional analagesia vs intra-articular analgesia. Arthroscopy 2000; 16(1): 64- 66.

5. Hardman J, Limbird L, Molinoff P, Ruddon R, Goodman Gilman A. Las bases farmacológicas de la terapéutica. McGraw-Hill Interamericana. Novena Edición, Vol. I, 1996: 581.

6. Ho, Shung-Tai, Wang, Jhi Joung, Tang, Jhonson Jiansheng, Liaw Wen-Jinn, Ho, Chiu. Ming. Pain relief after arthroscopic knee surgery: Intravenous morphine, epidural morphine and intra-articular morphine. Clinical Journal of Pain. 2000; 16(2): 105-109.

7. Joshi G, Mc Carroll N, Cooney C, Blunnie W, O’Brien T, Lawrence A. Intra-articular morphine for pain relief after knee arthroscopy. J Bone Joint Surg (Br) 1992; 74-B(5): 749-751.

8. Klein S, Nielsen K, Martin A, White W, Warner D, Steele S, Speer K, Greengrass R. Interscalene brachial plexus block with continuous intraarticular infusion of ropivacaine. Anesthesia & Analgesia. 2001; 93(3): 601-605.

9. Miller R. Anestesia. Harcout Brace. Cuarta Edición, Vol. 2. 1998: 2074.

10. Olof Lundin, Bengt Rydgren, Leif Swärd, Jon Karlson. Analgesic effects of intra-articular morphine during and after knee arthroscopy: A comparison of two methods. Arthroscopy 1998; 14 (2): 192-196.

11. Pooni JS, Hickmont K, Mercer D, Myles P, Khan Z. Comparison of intra-articular fentanil and intra-articular bupivacaine for post-operative pain relief after knee arthroscopy. European Journal of Anaesthesiology 1999; 16(10): 708-711.

12. Pynsent P, Fairbank J, Carr A. Medición de los resultados en ortopedia. Masson, 1996: 19-33.

13. Reuben S, Sklar J. Pain management in patients who undergo outpatient arthroscopic surgery of the knee. J Bone Joint Surg Am. Vol. 2000; 82A(12): 1754-1766.

14. Reuben S, Sklar J, El-Mansouri M. The preemptive analgesic effect of intraarticular bupivacaine and morphine after ambulatory arthroscopic knee surgery. Anesthesia & Analgesia. 2001; 92(4): 923-926.

15. Ritchie E, Tong D, Chung F, Norris A, Miniaci A, Vairavanathan S. Supraescapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: A new modality? 1997; 84(6): 1306-1312.

16. Rosseland L, Stubhaug A, Skoglund A, Breivik H. Intra-articular morphine for pain relief after knee arthroscopy. Acta Anaesthesiologica Escandinavica. 1999; 43(3): 252-257.

17. Villanueva L, Shaikh S, Psichoyios V, Crawford E. Ropivacaine vs bupivacaine as intra-articular pain relief after knee arthroscopy. A prospective double-blind randomized trial. J Bone Joint Surg (Br). 2000; 82-B: 144.

18. Vranken J, Vissers K, Jongh R, Heylen R. Intra-articular sufentanil administration facilitates recovery after day-case knee arthroscopy. Anesthesia & Analgesia. 2001; 92(3): 625-628.