Mehmet Akif AKÇAL, Ebru GÖKSU, İlkay BAYAR, Emel Ece ÖZCAN-EKŞİ

Artroskopik rotator manşet ameliyatlarında genel anestezi ile kombine genel ve rejiyonel anestezi kullanımının postoperatif ağrıya olan etkisi: Randomize kontrollü çalışma

INTRODUCTION: Postoperative pain seen in the first 48 hours after surgery, is an important problem and various methods are used in postoperative pain control. This study aims to investigate the effects of general anesthesia and combined general and regional anesthesia use on postoperative pain in arthroscopic rotator cuff repair operations. METHODS: Twenty-eight female patients admitted to who were planned for arthroscopic rotator cuff surgery were included. The patients were randomly divided into two groups. Pain levels of the groups at the 6th, 12th, and 24th hours were evaluated with the Visual Analogue Scale (VAS). The findings were analyzed with Student’s-t test and Mann-Whitney U test using SPSS 18.0 statistical program. RESULTS: The average age of the Group 1 was 57 (45 ± 68); and the average age of the patients in Group 2 was 57.93 (47 ± 69). The postoperative pain levels of the Group 1 were 1.57 (± 1.74) at the 6th hour; 2.57 (± 1.28) at the 12th hour, 2.71 (± 1.20) at the 24th hour; in Group 2 the 6th hour pain level was 8.00 (± 1.75); 12th hour level was 7.00 (± 1.52); and it was 6.00 (± 1.57) at the 24th hour. There was a statistically significant difference in all measurements in terms of VAS scores (p <0.001). DISCUSSION AND CONCLUSION: It is concluded that implementation of scalene block in addition to general anesthesia, increases the success of the operation in arthroscopic rotator cuff repair surgery.

Anahtar Kelimeler:

postoperatif ağrı, analjezi, interskalen blok, artroskopik rotator manşet tamiri

The effect of general anesthesia and combined general and regional anesthesia on postoperative pain in arthroscopic rotator cuff surgery: a randomized controlled prospective study

Keywords:

postoperative pain, analgesia, interscalene block, arthroscopic rotator cuff repair,

PDF

___

Sir E, Orhan M, Eckert S, Özkan G, Purtuloğlu T, Atım A, Atik B, Kurt E. Comparison of Ultrasound and Peripheral Nerve Stimulator Guidance for Interscalene Brachial Plexus Block in Shoulder Arthroscopy Patients. Muğla Med J. 2019;6: 99-104.
Warrender WJ, Syed UAM, Hammoud S, Emper W, Ciccotti MG, Abboud JA, Freedman KB. Pain management after outpatient shoulder arthroscopy: a systematic review of randomized controlled trials. Am J Sports Med. 2017;45:1676-86.
Ganapathy S, Amendola A, Lichfield R, Fowler PJ, Ling, E. Elastomeric pumps for ambulatory patient-controlled regional analgesia. Can J Anesth. 2000;47:897-902.
Mather RC, Koenig L, Acevedo D, Dall TM, Gallo P, Romeo A, Tongue J. et al. The societal and economic value of rotator cuff repair. J Bone Joint Surg Am. 2013;95:1993 – 2000.
Boss AP, Maurer T, Seiler S, Aeschbach A, Hintermann B, Strebel S. Continuous subacromial bupivacaine infusion for postoperative analgesia after open acromioplasty and rotator cuff repair: preliminary results. J Shoulder Elb Surg. 2004;13: 630-34.
Oh JH, Kim WS, Kim JY, Gong HS, Rhee KY. Continuous intralesional infusion combined with interscalene block was effective for postoperative analgesia after arthroscopic shoulder surgery. J. Shoulder Elb Surg. 2007;16:295-99.
Cho CH, Song KS, Min BW, Jung GH, Lee YK, Shin HK. Efficacy of interscalene block combined with multimodal pain control for postoperative analgesia after rotator cuff repair. Knee Surg Sports Traumatol Arthrosc. 2015;23:542-47.
Çelik H, Seçkin MF, Akman Ş. Complications of Rotator Cuff Surgery. Eur Arc Med Res. 2017;33:155-63.
Ilfeld BM, Morey TE, Wright TW, Chidgey LK, Enneking FK. Continuous interscalene brachial plexus block for postoperative pain control at home: a randomized, double-blinded, placebo-controlled study. Anesth. Analg.2003;96:1089-95.
Uquillas CA, Capogna BM, Rossy WH, Mature SA, Rokita AS. Postoperative pain control after arthroscopic rotator cuff repair. J Shoulder Elb Surg. 2016;25:1204-13.
Saito M, Tsukada S, Fujita N, Rahman M, Morita W, Kitamura N. et al. Postoperative pain control following arthroscopic rotator cuff repair: peri-articular injection versus interscalene brachial plexus block. Int Orthop. 2019;43:1435-41.
Borgeat A, Kalberer F, Jacob H, Ruetsch YA, Gerber C. Patient-controlled interscalene analgesia with ropivacaine 0.2% versus bupivacaine 0.15% after major open shoulder surgery: the effects on hand motor function. Anesth Analg. 2001;92:218-23.
Gautier P, Vandepitte C, Ramquet C, DeCoopman M, Xu D, Hadzic A. The minimum effective anesthetic volume of 0.75% ropivacaine in ultrasound-guided interscalene brachial plexus block. Anesth Analg. 2011;113:951-5.
Salviz EA, Xu D, Frulla A, Kwofie K, Shastri U, Chen, J. et al. Continuous interscalene block in patients having outpatient rotator cuff repair surgery: a prospective randomized trial. Anesth Analg. 2013;117:1485-92.
Chelly JE, Greger J, Gebhard R, Coupe K, Clyburn TA, Buckle, R et al. Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty.J Arthroplasty. 2001;16:436-45.
Neuts A, Stessel B, Wouters PF, Dierickx C, Cools W, Ory JP et al. Selective suprascapular and axillary nerve block versus interscalene plexus block for pain control after arthroscopic shoulder surgery: a noninferiority randomized parallel-controlled clinical trial. Reg Anesth Pain Med. 2018;43:738-44.
Hadzic A, Williams BA, Karaca PE, Hobeika P, Unis G, Dermksian J. et al. For outpatient rotator cuff surgery, nerve block anesthesia provides superior same-day recovery over general anesthesia. Anesthesiology. 2005;102:1001-7.
Koltka AK, Büget M, Bingül ES, Erşen A, Küçükay S, Atalar AC. et al. Postoperative analgesia after arthroscopic shoulder surgery: a comparison between single-shot interscalene block and single-shot supraclavicular block. Pain. 2017;29:127-31.
Boddu C, Ginza A, McCann PD. Bridging multimodal pain management provides 48-hour pain control in patients undergoing total shoulder replacement. J Shoulder Elb Surg, 2018;27:65-9.
Ekinci M, Çatal B, Baysal PK, Gölboyu BE, Aksum M, Baysal Ö. et al. Omuz artroskopi ameliyatlarında interskalen blok ile tek doz eklem içi lokal anestezik uygulamasının postoperatif analjezik etkinliklerinin karşılaştırılması. Bozok Med. J. 2016;6:39-45.
Cohen J. The analysis of variance. In Statistical Power Analysis for the Behavioral Sciences. Second ed, Lawrence Erlbaum Associates. 1988; 274-287.
Krone SC, Chan VW, Regan J, Peng P, Poate EM, McCartney C. et al. Analgesic effects of low-dose ropivacaine for interscalene brachial plexus block for outpatient shoulder surgery—a dose-finding study. Reg Anesth Pain Med. 2001;26:439-43.
Koga R, Funakoshi T, Yamamoto Y, Kusano H. Suprascapular nerve block versus interscalene block for analgesia after arthroscopic rotator cuff repair. J Orthop 2020;19:28-30.
Bingöl O, Deveci A, Başkan S, Özdemir G, Kiliç E, Arslantaş E. Comparison of local infiltration analgesia and interscalene block for postoperative pain management in shoulder arthroscopy: a prospective randomized controlled trial. Turk J Med Sci. 2021. Doi: 10.3906/sag-2008-57
Toyooka S, Ito M, Kakinuma A, Kayama S, Watanabe K, Miyamoto W. Et al. Periarticular multimodal drug injection does not improves early postoperative analgesia compared with continuous interscalene brachial plexus block after arthroscopic rotator cuff repair: A retrospective single-center comparative study. J Orthop Sci, 2020;25:405-9.
Sahu GK, Meena DS, Saini S, Aravindan A, Datta PK. Comparison of two different volumes of ropivacaine used in nerve stimulator guided inter-scalene block for arthroscopic shoulder surgery–A randomized controlled trial. Anesth Essays Res. 2018;12:786-91.