Background and Goal of Study: Home analgesia after arthroscopy of the shoulder is a challenge, which we solve with interscalene catheters and a perfusion of 0.2% ropivacaine during the first 48 hours. The rate of failures with this technique, although small (9%), leads to the failure of pain control which is difficult to resolve when the patient is already home. To control this pain we introduced intravenous analgesic perfusion.
Materials and Methods: 52 patients were divided into two groups: Group I: n=38 interscalene nerve block with catheter for continuous perfusion of ropivacaine 0.2% 5ml/h for 48 hours and Group II: single-shot interscalene injection and postoperative continuous intravenous perfusion with Dexketoprofen Trometamol 300mg, Metamizole 1200mg and Ranitidine 3000 mg dissolved in saline at a rate of 5ml/h, for 48 hours. A verbal score was taken on entering PACU, after 24h, 48h, 72h and 7 days.
Results and Discussion: Mean stay in PACU was 67 min, time until oral tolerance was 82 min, time until discharge was 248 ± 62 minutes. There were no statistically significant differences between the 2 groups at any of the timelines studied. The analgesic requirements in PACU were significantly higher in group II. Mean scores for postoperative pain were lower in patients receiving the interescalene pump compared to those receiving intravenous perfusion, at all the time points studied, although this was not significant. Rescue analgesia consumption was the same in both groups. In group II, there was one phlebitis.
Conclusion(s): Postoperative analgesia with an elastomeric pump and continuous perfusion with Ropivacaine 0.2% for 48hours is still the preferred technique in our unit. Endovenous analgesic perfusion is an effective alternative and accepted by patients when the continuous interscalene block is not very effective.