Postoperative analgesia with bupivacaine and morphine through an intra-articular catheter in shoulder surgery

Abstract

Introduction: decompressive surgery is relatively common in shoulder pain syndrome. Postsurgical pain hampers the early rehabilitation of these patients and their reincorporation to work and social life. Objective: evaluate and demonstrate the efficacy of the use of the bupivacaine-morphine combination vs. bupivacaine alone, administered through an intra-articular catheter, for postoperative analgesia and rehabilitation in shoulder surgery. Methods: an analytical prospective longitudinal study was conducted with 80 patients of both sexes aged 40-65 cared for at "Dr. Luis Diaz Soto" Central Military Hospital in Havana, which extended from October 2009 to May 2010. The patients were randomly distributed into 2 groups, each with 40 members. In Group I, 2 mg of lyophilized morphine were added to the local anesthetic every 24 hours. In Group II, only 0.25 % bupivacaine (20 mL) was added every 6 hours. Postoperative analgesia was evaluated with the Analog Visual Scale (AVS). Results were compared by means of a chi-square test with a 95 % confidence degree. Results: on average, prolongation of combined postoperative analgesia in Group I was 13.5 hours vs. 4.55 hours in Group II, where only bupivacaine was used during the first 24 hours. A better evolution of pain was also observed in Group I during the next 24 to 48 hours. Conclusions: administration of the anesthetic mixture combined with the analgesic through an intra-articular catheter to relieve postoperative pain in shoulder surgery is more effective, with mild, easily manageable side effects, thus enabling early rehabilitation.

Keywords

• dolor posoperatorio, bupivacaína y morfina, opioides periféricos, cirugía de hombro, analgesia combinada.