Advertisement

Postoperative Fentanyl Patch Versus Subacromial Bupivacaine Infusion in Arthroscopic Shoulder Surgery

      Purpose

      The purpose of our study was to compare the effectiveness of subacromial bupivacaine infusion and a transdermal fentanyl patch in the treatment of postoperative pain after arthroscopic shoulder surgery.

      Methods

      Sixty patients with rotator cuff disease scheduled for elective arthroscopic shoulder surgery were enrolled in the study. For the treatment of postoperative pain, 30 patients constituted group F and received a 12.0-μg/h fentanyl patch for 72 hours and saline solution infusion in a subacromial manner at the rate of 4 mL/h. The remaining 30 patients constituted group B and received a placebo patch and an infusion of 2.5-mg/mL bupivacaine in a subacromial manner for 72 hours. The primary outcome measure was the postoperative numerical rating scale pain score. The consumption of opioids, ibuprofen, and acetaminophen was also recorded. The Constant scores and general recovery were followed up until the 90th postoperative day.

      Results

      There was no statistically significant difference in the numerical rating scale scores (P = .60) between the groups. No differences in the use of rescue analgesic were observed except that the patients receiving bupivacaine used more ibuprofen (median, 1,200 mg v 600 mg) during the day of surgery (P = .042). No difference was found in general recovery between the groups.

      Conclusions

      A fentanyl patch delivering 12-μg/h fentanyl offers an easy and safe treatment option as a part of multimodal analgesia with few adverse effects in the treatment of postoperative pain in a carefully selected patient group after arthroscopic shoulder surgery.

      Level of Evidence

      Level I, randomized controlled trial.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lenters T.R.
        • Davies J.
        • Matsen III, F.A.
        The types and severity of complications associated with interscalene brachial plexus block anesthesia: Local and national evidence.
        J Shoulder Elbow Surg. 2007; 16: 379-387
        • Barber F.A.
        • Herbert M.A.
        The effectiveness of an anesthetic continuous-infusion device on postoperative pain control.
        Arthroscopy. 2002; 18: 76-81
        • Webb D.
        • Guttmann D.
        • Cawley P.
        • Lubowitz J.H.
        Continuous infusion of a local anesthetic versus interscalene block for postoperative pain control after arthroscopic shoulder surgery.
        Arthroscopy. 2007; 23: 1006-1011
        • Fredrickson M.J.
        • Krishnan S.
        • Chen C.Y.
        Postoperative analgesia for shoulder surgery: A critical appraisal and review of current techniques.
        Anesthesia. 2010; 65: 608-624
        • Gourlay G.K.
        • Kowalski S.R.
        • Plummer J.L.
        • Cherry D.A.
        • Gaukroger P.
        • Cousins M.J.
        The transdermal administration of fentanyl in the treatment of postoperative pain: Pharmacokinetics and pharmacodynamic effects.
        Pain. 1989; 37: 193-202
        • Caplan R.A.
        • Ready L.B.
        • Oden R.V.
        • Matsen F.A.
        • Nessly M.L.
        • Olsson G.L.
        Transdermal fentanyl for postoperative pain management. A double-blind placebo study.
        JAMA. 1989; 261: 1036-1039
        • Constant C.R.
        • Murley A.H.
        A clinical method of functional assessment of the shoulder.
        Clin Orthop. 1987; 214: 160-164
        • Van Bastelaere M.
        • Rolly G.
        • Abdullah N.M.
        Postoperative analgesia and plasma levels after transdermal fentanyl for orthopedic surgery: Double-blind comparison with placebo.
        J Clin Anesth. 1995; 7: 26-30
        • Stiglitz Y.
        • Gosselin O.
        • Sedaghatian J.
        • Sirveaux F.
        • Molé D.
        Pain after shoulder arthroscopy: A prospective study on 231 cases.
        Orthop Traumatol Surg Res. 2011; 97: 260-266
        • Coghlan J.A.
        • Forbes A.
        • McKenzie D.
        • Bell S.N.
        • Buchbinder R.
        Efficacy of subacromial ropivacaine infusion for rotator cuff surgery. A randomized trial.
        J Bone Joint Surg Am. 2009; 91: 1558-1567
        • Merivirta R.
        • Kuusniemi K.S.
        • Aantaa R.
        • Hurme S.A.
        • Äärimaa V.
        • Leino K.A.
        The analgesic effect of continuous subacromial bupivacaine infusion after arthroscopic shoulder surgery: A randomized controlled trial.
        Acta Anaesthesiol Scand. 2012; 56: 210-216
        • Busfield B.T.
        • Romero D.M.
        Pain pump use after shoulder arthroscopy as a cause of glenohumeral chondrolysis.
        Arthroscopy. 2009; 25: 647-652
        • Solomon D.J.
        • Navaie M.
        • Stedje-Larsen E.T.
        • Smith J.C.
        • Provencher M.T.
        Glenohumeral chondrolysis after arthroscopy: A systematic review of potential contributors and causal pathways.
        Arthroscopy. 2009; 25: 1329-1342
        • Rosenberg P.
        • Renkonen O.
        Antimicrobial activity of bupivacaine and morphine.
        Anesthesiology. 1985; 62: 178-179
        • Busfield B.T.
        • Lee G.H.
        • Carrillo M.
        • Ortega R.
        • Kharrazi F.D.
        Subacromial pain pump use with arthroscopic shoulder surgery: A short-term prospective study of complications in 583 patients.
        Arthroscopy. 2008; 17: 860-862
      1. Summary of product characteristics, Durogesic. Espoo: Janssen-Cilag, 2012.

        • Gourlay G.K.
        • Kowalski S.R.
        • Plummer J.L.
        • et al.
        The efficacy of transdermal fentanyl in the treatment of postoperative pain: A double-blind comparison of fentanyl and placebo systems.
        Pain. 1990; 40: 21-28
        • Sandler A.N.
        • Baxter A.D.
        • Katz J.
        • et al.
        A double-blind, placebo-controlled trial of transdermal fentanyl after abdominal hysterectomy analgesic, respiratory, and pharmacokinetic effects.
        Anesthesiology. 1994; 81: 1169-1180
        • Savoie F.H.
        • Field L.D.
        • Jenkins R.N.
        • Mallon W.J.
        • Phelps R.A.
        The pain control infusion pump for postoperative pain control in shoulder surgery.
        Arthroscopy. 2000; 16: 339-342
        • Howick J.
        Questioning the methodologic superiority of “placebo” over “active” controlled trials.
        Am J Bioeth. 2009; 9: 34-48
        • Petrini C.
        Ethical issues in the difference between placebo-controlled and active-controlled trials.
        Am J Bioeth. 2009; 9: 56-58
        • Joshi G.P.
        Multimodal analgesia techniques for ambulatory surgery.
        Int Anesthesiol Clin. 2005; 43: 197-204
        • Schug S.A.
        • Chong C.
        Pain management after ambulatory surgery.
        Curr Opin Anaesthesiol. 2009; 22: 738-743
        • Elvir-Lazo O.L.
        • White P.F.
        The role of multimodal analgesia in pain management after ambulatory surgery.
        Curr Opin Anaesthesiol. 2010; 23: 697-703