Kemalettin KOLTA, Behiye DOĞRUEL, Mert ŞENTÜRK, ATA CAN ATALAR, Süleyman KÜÇÜKAY, Kamil PEMBECİ

Postoperative analgesia for arthroscopic rotator cuff surgery: A comparison between subacromial and interscalene levobupivacaine

Giriş: Artroskopik rotator kaf cerrahisi şiddetli ağrıya neden olabilir. Çalışmamızda artroskopik rotator kaf cerrahisi hastalarında subakromiyal kateterden devamlı uygulanan levobupivakain infüzyonu ile interskalen kateterden devamlı uygulanan levobupivakain infüzyonu karşılaştırılmıştır. Gereç ve Yöntem: 60 hasta iki gruba randomize olarak ayrıldı: 1) 30 ml %0.5 levobupivakain ile tek doz interskalen blok sonrasında subakromial kateterden %0.125 levobupivakain 5 ml/s bazal infüzyon, 5 ml bolus doz ve kilitli kalma 20 dakika 2) 30 ml %0.5 levobupivakain ile interskalen blok sonrasında interskalen kateterden %0.125 levobupivakain 5 ml/s bazal infüzyon, 5 ml bolus doz ve kilitli kalma 20 dakika. İnfuzyonlara 48 saat süre devam edildi. Bulgular: Derlenme odasındaki ve 4 saat sonraki VAS değerleri açısından gruplar arası fark yoktu. Çalışmamızda 8, 12, 24, 36 ve 48. saatlerde VAS değerleri iki grupta da medyan değer olarak 4’ten küçük olmakla beraber interskalen grupta istatistiksel olarak anlamlı derecede daha düşüktü. Ek analjezik gereksinimi interskalen grupta istatistiksel olarak anlamlı derecede daha azdı (%16,6 ve %53,3, p< 0,05). Hasta memnuniyeti interskalen grupta istatistiksel olarak anlamlı derecede daha yüksekti (9,4 ± 0,8 ve 8 ± 1, 2, p

Artroskopik rotator kaf cerrahisi için postoperatif analjezi: Subakromiyal ve interskalen levobupivakainin karşılaştırılması

Introduction: Arthroscopic rotator cuff surgery can result in severe postoperative pain. We compared a continuous subacromial infusion to a continuous interscalene block with levobupivacaine for patients undergoing arthroscopic rotator cuff surgery. Methods: Sixty patients were randomized to two groups: 1) interscalene block with 0.5% levobupivacaine (30 mL) followed by a postoperative subacromial infusion: 0.125% levobupivacaine 5 mL/h basal infusion, 5mL bolus dose and a 20 min lockout time or; 2) interscalene block with 0.5% levobupivacaine (30 mL) followed by a postoperative interscalene infusion: 0.125% levobupivacaine 5 mL/h basal infusion, 5mL bolus dose and a 20 min lockout time. Infusions were maintained for 48 hours. Results: The VAS scores in the postanesthesia care unit and at 4 h were not different. The VAS scores at 8, 12, 24, 36 and 48 h were lower than 4 in both groups; but they were significantly lower in the interscalene group. Additional analgesic requirements were lower in the interscalene group (16.6% vs 53.3%, p<0.05). Patients’ satisfaction was higher in the interscalene group (9,4 ± 0,8 vs 8 ± 1,2, p<0,01). One patient had a toxicity related to interscalene block but; there was no complication related to subacromial catheters. Conclusions: This study demonstrates that subacromial infusions, although provided good postoperative analgesia, are not as effective as interscalene infusions and additional analgesics should be prescribed when subacromial infusions are started. Subacromial infusions could be considered as an alternative in case of any contraindication to interscalene block.

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