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Efficacy of Subacromial Ropivacaine Infusion for Rotator Cuff Surgery: A Randomized Trial

Coghlan, Jennifer A. BAppSci(Advanced Nursing [Crit.Care]), BA, PhD, FRCNA; Forbes, Andrew PhD, BSc(Hons), MSc; McKenzie, Dean BA(Hons); Bell, Simon N. MBBS, FRCS, FRACS, FAOrthA, PhD; Buchbinder, Rachelle MBBS(Hons), MSc, PhD, FRACP

Journal of Bone & Joint Surgery - American Volume: 01 July 2009 - Volume 91 - Issue 7 - p 1558–1567
doi: 10.2106/JBJS.H.00948
Scientific Articles

Background: Local anesthetic administered directly to the operative site by slow infusion has become a popular supplementary pain management strategy following rotator cuff surgery, but it is expensive and there is little conclusive evidence that it provides additional benefits. The purpose of this study was to determine the effectiveness and safety of ropivacaine infusion following arthroscopic or mini-incision rotator cuff surgery.

Methods: We performed a randomized, participant and outcome assessor-blinded, placebo-controlled trial. Participants, stratified by operative procedure (either arthroscopic decompression or rotator cuff repair), were given preemptive 1% ropivacaine (20 mL) and intraoperative intravenous parecoxib (40 mg) and were randomly assigned to 0.75% ropivacaine or placebo by elastomeric pump at 5 mL/hr. Pain at rest was reported on a verbal analogue scale at fifteen, thirty, and sixty minutes and at two, four, eight, twelve, eighteen, and twenty-four hours. The use of alternative analgesia, delay in discharge, and adverse events, including development of stiff painful shoulder, infection, and leakage, were also assessed.

Results: Eighty-eight participants received arthroscopic decompression (forty-three in the placebo arm and forty-five in the ropivacaine arm) and seventy received rotator cuff repair (thirty-five participants in each treatment arm). Compared with placebo, ropivacaine infusion resulted in a significant but clinically unimportant improvement in average pain in the first twelve hours following both procedures (the average pain score was 1.62 and 2.16 for the ropivacaine and placebo arms, respectively, in the arthroscopic decompression group and 2.12 and 2.82 in the rotator cuff repair group, with a pooled difference between groups of 0.61; 95% confidence interval, 0.22 to 1.01; p = 0.003). When adjusted for opioid use, the pooled difference between groups was 0.49 (95% confidence interval, 0.12 to 0.86; p = 0.009). No difference was detected between groups with regard to the maximum pain in the first twelve hours or the average or maximum pain in the second twelve hours, with or without adjustment for opioid use, and no difference was found between groups with regard to the amount of oral analgesia used. No difference was detected between groups with regard to the prevalence of nausea and vomiting, catheter leakage, delayed discharge, or stiff painful shoulder, and no participant in either group had a postoperative infection develop.

Conclusions: We found minimal evidence to support the use of ropivacaine infusion for improving outcomes following rotator cuff surgery in the setting of preemptive ropivacaine and intraoperative parecoxib.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

1Monash Department of Clinical Epidemiology at Cabrini Hospital and Department of Epidemiology and Preventive Medicine, Monash University, Suite 41, Cabrini Medical Centre, 183 Wattletree Road, Malvern, Victoria 3144, Australia. E-mail address for R. Buchbinder: rachelle.buchbinder@med.monash.edu.au

2Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 89 Commercial Road, Melbourne, Victoria 3004, Australia

3Upper Limb Unit, Monash Medical Centre Division of Orthopaedics, Monash University Department of Surgery, Melbourne, and The Melbourne Shoulder and Elbow Centre, 31 Normanby Street, Brighton, Victoria 3186, Australia

Copyright 2009 by The Journal of Bone and Joint Surgery, Incorporated
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