Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · May 2007
Randomized Controlled Trial Comparative StudyContinuous intralesional infusion combined with interscalene block was effective for postoperative analgesia after arthroscopic shoulder surgery.
The purpose of this study was to compare the efficacy of postoperative pain control by intravenous patient-controlled analgesia (IV) and by continuous intralesional infusion of a local anesthetic (IL) with or without an interscalene block (ISB) after arthroscopic shoulder surgery. We allocated 84 patients to 4 groups according to analgesic method: IV, ISB-IV, IL, and ISB-IL. Postoperative pain, side effects, and supplementary analgesics were recorded at 1 hour and then every 8 hours for 48 hours. ⋯ Patients in group ISB-IL had less pain at 16 and 48 hours postoperatively than those in the other groups (P < .05). Continuous intralesional infusion (groups IL and ISB-IL) was superior in reducing analgesic-related side effects (P < .05). This study suggests that a combination of an interscalene block and continuous intralesional infusion of a local anesthetic is an effective and safe method of postoperative pain control after arthroscopic shoulder surgery.
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J Shoulder Elbow Surg · Nov 2004
Randomized Controlled Trial Comparative Study Clinical TrialContinuous subacromial bupivacaine infusion for postoperative analgesia after open acromioplasty and rotator cuff repair: preliminary results.
Shoulder surgery is often associated with severe postoperative pain. Previous results in which single or continuous subacromial infiltration of local anesthetics was used as a method of postoperative pain relief have been contradictory. This study was initiated to evaluate the postoperative analgesic effect of a subacromial continuous 0.25% bupivacaine infusion at a rate of 6 mL/h after elective open shoulder surgery. ⋯ No major technical or pharmacologic side effects were noticed, and the indwelling pain catheter was well tolerated by all patients. There was no statistically significant difference (P < .05) either in total cumulative morphine consumption microg/48 h (73.2 +/- 43.1 vs 60.9 +/- 35.9) or in subjective pain perception 10-point visual analog scale (3.2 +/- 1.4 vs 3.1 +/- 1.5) between the two study groups. The continuous subacromial infiltration of 0.25% bupivacaine at a rate of 6 mL/h is concluded to be ineffective in providing pain relief supplementary to patient-controlled analgesia after open rotator cuff repair and acromioplasty surgery.
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J Shoulder Elbow Surg · Jul 2004
Randomized Controlled Trial Clinical TrialArthroscopic rotator cuff repair with and without arthroscopic subacromial decompression: a prospective, randomized study of one-year outcomes.
We performed a prospective, randomized study to determine whether arthroscopic subacromial decompression changes the outcome of rotator cuff repair. We performed a power analysis to ensure statistical validity. Patients scheduled for arthroscopic rotator cuff repair were randomized to cuff repair with arthroscopic subacromial decompression (group 1) or without it (group 2). ⋯ There was no statistical difference in postoperative ASES scores between group 1 (91.5 +/- 10.3) and group 2 (89.2 +/- 15.1) (P =.392). The change in ASES score over time did not differ between the two groups (61.1 vs 60.2, P =.363). In conclusion, within the parameters described above, arthroscopic subacromial decompression does not appear to change the functional outcome after arthroscopic repair of the rotator cuff.
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J Shoulder Elbow Surg · Jul 2002
Randomized Controlled Trial Comparative Study Clinical TrialCemented polyethylene versus uncemented metal-backed glenoid components in total shoulder arthroplasty: a prospective, double-blind, randomized study.
Thirty-nine patients (forty shoulders) with primary osteoarthritis consented to be randomized to receive either a cemented all-polyethylene glenoid component or a cementless metal-backed component at the time of total shoulder arthroplasty. Their mean age was 69 years. Preoperative and postoperative evaluations were completed at 3, 6, 12, 24, and 36 months by history, physical examination, radiographs, and Constant scoring system. ⋯ At a minimum of 3 years' follow-up, the results of this study clearly show that (1) the survival rate of cementless, metal-backed glenoid components is inferior to cemented all-polyethylene components and (2) the incidence of radiolucency at the glenoid-cement interface with all-polyethylene components is high and remains a concern. The high rate of loosening, because of the absence of ingrowth and/or the accelerated polyethylene wear, has led us to abandon the use of metal-backed glenoids. Efforts must continue to improve glenoid component design and fixation.