抄録
The purpose of this study was to assess the efficacy of an alternative method of postoperative pain control with continuous epidural and single-shot interscalene block for arthroscopic rotator cuff repair(ARCR). 100 consecutive patients who underwent ARCR were enrolled. Continuous epidural (CE) group consisted of 52 cases, 32 men and 20 women, whose average age at surgery was 64.5 years old. Single-shot interscalene block (IS) group consisted of 48 cases, 28 men and 20 women, whose average age at surgery was 63.9 years old. Surgery was done under general anesthesia, performed by a single surgeon in a beach-chair position. The patients' backgrounds of both groups were not uneven. In group-CE, a 2%-lidocaiine was administrated intra-operatively and 0.2%-ropivacaine was given via a continuous epidural catheter for 2-4 days postoperatively. In group-IS, a 0.75%-ropivacaine was injected into the interscalene compartment following induction of general anesthesia. Postoperative rehabilitation started at 1POD, in the same regimen for all patients. We evaluated pains at the time of recovery from general anesthesia, at night of the surgery, at the time of the 1st postoperative rehabilitation and the patients' satisfaction of postoperative pain using VAS-scales (0-10). We also investigated complications related to anesthesia, functional evaluation using the Japanese Orthopaedic Association shoulder score (JOA-SS) and QuickDASH.
The ratio of patients who had pain at recovery from general anesthesia was 7.6% in group-CE and 8.3% in group-IS, without a difference. Pain the night of the surgery, patients' satisfaction also had no significant differences. Pain at first postoperative rehabilitation was significantly lower in group-CE. No complications including infection or prolonged nerve palsy were observed in any cases. Postoperative functional scores using JOA-SS and QuickDASH after surgery had no difference in either group. We conclude that a single-shot interscalene block was safe and effective for arthroscopic rotator cuff repair equal to a continuous epidural block.
