Abstract

ORTIZ DE LA TABLA, R.; MARTINEZ, A. M.; VAZQUEZ, T.  and  ECHEVARRIA, M.. Continuous Intersternocleidomastoid PCA analgesia Vs intravenous PCA analgesia after proximal shoulder surgery. Rev. Soc. Esp. Dolor [online]. 2008, vol.15, n.7, pp.444-450. ISSN 1134-8046.

Objectives: We have compared results in postoperative analgesia and incidence of side effects between a continuous intersternocleidotnastoid blockade and intravenous analgesia after proximal shoulder surgery. Methods: In a prospective no randomized study on patients scheduled for unilateral shoulder surgery under general anaesthesia with intravenous fentanil as intraoperative analgesia. In group 1, a continuous intersternocleidomastoid blockade was performed with a bolus of ropivacaine 0,5% 0,4 mL/kg before surgery and a postoperative patient-controlled analgesia (PCA) infusión pump of 0,2% ropivacaine (5ml/h, PCA bolus 5 mi / 30 minutes) was started in the recuperation unit. In group 2, an initial intravenous bolus of 2 gr magnesium metamizol, 100 mg tramadol and 4 mgr ondansetron was administered when patient arrived to recuperation unit and followed by a PCA infusión of 0,16% magnesium metamizol, 0,04% tramadol and 0,0016% ondansetron (1,5 mL h-1, PCA bolus 1 mL/20 minutes) was started. The principal data analized was postoperative pain, at rest and during movement by an analogic numeric scale (0 no dolor, 10 máxime dolor) and the incidence of side effects. Results: We included 38 patients in group 1 and 39 in group 2. The evaluation of postoperative pain demostrated elevated pain seores during movement at first 24 hours and at rest and during movement at 48 hours in group 2, with significant stadistical differences (p<0,05). Minor complications were observed, in group 1 a recurrence laryngeal nerve blockade in two patients, a transient Horner’s syndrome in 2 patients and vomitus in three patients. And in group 2, 12 patients presented nauseas and vomitus and another 3 patients presented sedation. Discussion: PCA by intersternocleidomastoid blockade was an effective and well tolerated technique in our study and it provided better pain scores than intravenous PCA with lower side effects in the first 48 hours after shoulder surgery.

Keywords : Continuous intersternocleidomastoid blockade; continuous interscalenic blockade; patient-controlled analgesia; shoulder surgery.

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