Patient-controlled analgesia after major shoulder surgery - Patient-controlled interscalene analgesia versus patient-controlled analgesia

Background: The authors compared patient-controlled interscalene analgesia (PCIA) with local anesthetics with intravenous patient-controlled analgesia (PCA) with opioids to manage postoperative pain after major shoulder surgery. Methods: Forty patients scheduled for elective major shoulder surgery were prospectively randomized to receive either PCIA or PCA. Before surgery, all patients had an interscalene block. In the PCIA group, a catheter was introduced within the interscalene sheath. Six hours after the initial block, patients received for 48 h either a continuous infusion of 0.15% bupivacaine through the interscalene catheter at a rate of 5 ml/h plus a bolus of 5 or 4 mi with a lock-time of 20 min (group PCIA) or a continuous intravenous infusion of nicomorphine at a rate of 0.5 mg/h plus a bolus of 2 or 5 mg with a lock-time of 20 min (group PCA), Pain relief was regularly assessed using a visual analog scale, side effects were noted, and the patients were asked to rate their satisfaction at the end of the study. Results: Pain relief was significantly better controlled in the PCIA group at t = 12 and 18 h (P < 0.05), Vomiting and pruritus were 0 versus 25% and 0 versus 25% for the PCM and PCA groups, respectively (P < 0.05). Patient satisfaction was greater in the PCIA group (P < 0.05). Time of first bolus administration and paracetamol supplement were similar in both groups. Conclusions: The use of the PCIA technique was uncomplicated and provided better pain relief than PCA during the first 18 h after operation, The incidence of side effects such as vomiting and pruritus was significantly decreased with the use of PCIA, and patient satisfaction was superior in the PCIA group.