Effect of patient-controlled perineural analgesia on rehabilitation and pain after ambulatory orthopedic surgery: a multicenter randomized trial.

Abstract

BACKGROUND:

Efficacy of continuous perineural and patient-controlled ropivacaine infusion at home after orthopedic surgery was compared with patient-controlled intravenous morphine for functional recovery and postoperative analgesia in a multicenter randomized trial.

METHODS:

Eighty-three patients scheduled to undergo acromioplasty or hallux valgus surgery received an interscalene (n = 40) or popliteal (n = 43) peripheral nerve block with 30 ml ropivacaine, 0.5%. After randomization, patients were discharged home 24 h after surgery with a disposable infusion pump delivering either patient-controlled intravenous morphine (n = 23) or perineural 0.2% ropivacaine infusion, either continuous infusion without bolus (n = 30) or basal infusion plus bolus (n = 30). The patients recorded pain scores on movement and/or walking and were directed to take paracetamol and rescue analgesics if necessary. The time necessary to be able to walk for 10 min; daily activities on days 1, 2, and 3; adverse events; and overall satisfaction scores were noted and graded by the patient.

RESULTS:

Basal-bolus ropivacaine decreased the time to 10 minutes' walk, optimized daily activities (P < 0.01), and decreased the amount of ropivacaine used. The morphine group had greater pain scores and consumption of morphine and ketoprofen compared with both ropivacaine groups (P < 0.05). The incidence of nausea/vomiting, sleep disturbance, and dizziness increased, and the patient satisfaction score decreased in the morphine group (P < 0.05).

CONCLUSIONS:

After ambulatory orthopedic surgery, 0.2% ropivacaine delivered as a perineural infusion using a disposable elastomeric pump with patient-controlled anesthesia bolus doses optimizes functional recovery and pain relief while decreasing the consumption of rescue analgesics and ropivacaine, and the number of adverse events.

• Authors: Xavier Capdevila, Christophe Dadure, Sophie Bringuier, Nathalie Bernard, Philippe Biboulet, Elisabeth Gaertner, Philippe Macaire
• Journal: Anesthesiology (Anesthesiology) Vol. 105 Issue 3 Pg. 566-73 (Sep 2006) ISSN: 0003-3022 [Print] United States
• PMID: 16931991 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)

Topics

• Adult
• Aged
• Ambulatory Surgical Procedures
• Analgesia, Patient-Controlled (adverse effects)
• Female
• Humans
• Male
• Middle Aged
• Orthopedic Procedures (rehabilitation)
• Pain Measurement
• Pain, Postoperative (drug therapy)