Pain Management After Shoulder Surgery
Abstract & Commentary
Synopsis: Pain control pumps have recently been investigated in order to minimize postoperative pain and use of narcotic medications. Early results for outpatient shoulder surgery are promising.
Source: Savoie FH, et al. The pain control infusion pump for postoperative pain control in shoulder surgery. Arthroscopy 2000;16:339-342.
Savoie and associates performed a prospective, randomized trial to evaluate the use of an indwelling subacromial catheter for continuous postoperative pain relief. Thirty-one patients were randomly assigned to saline infusions, and 31 patients were randomly assigned to 0.25% bupivacaine infusions. An indwelling infusion catheter was placed in the subacromial space intraoperatively and set to deliver a 2-cc-per-hour infusion for 48 hours postoperatively. Patients were then evaluated for postoperative pain using a visual analog scale, and the use of supplemental medications was monitored as well. There was a statistical difference in postoperative pain (P < 0.05) and the use of supplemental narcotic and non-narcotic medications in the group treated with bupivacaine. None of the patients developed any complications from the infusion system, and Savoie et al were able to teach the patients to remove their own catheters. Savoie et al suggest the use of a continuous infusion catheter system for postoperative pain control in the outpatient setting.
COMMENT BY STEPHEN B. GUNTHER, MD
This prospective, randomized study concludes that indwelling continuous infusion catheters are an effective means of preventing postoperative pain in outpatient shoulder surgery. The patients were able to manage their own catheters, and there were no complications related to the catheters. Clinical results of the arthroscopic procedures were not included.
Outpatient shoulder surgery has gained popularity as the breadth of arthroscopic procedures has multiplied. The constraints of our medical system have also demanded shorter hospital stays and more outpatient surgery.1 This study illustrates the importance of the patient in cost-based medicine. Outpatient procedures will remain popular if patients feel that they are well cared for and not caused to suffer unnecessarily. This study proves the efficacy of the analgesic infusion catheter. Although there were no complications related to its use in this patient setting, a larger series would help elucidate whether any complications may occur with its widespread use. A cost analysis would be helpful as well. However, it appears to be a safe and efficacious procedure likely to increase in popularity.
Reference
1. Mallon WJ, Thomas CW. Patient-controlled lidocaine analgesia for acromioplasty surgery. J Shoulder Elbow Surg 2000;9:85-88.
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