• A Borgeat, B Schäppi, N Biasca, and C Gerber.
• Department of Anesthesia and Orthopedic Surgery, University Clinic of Zurich/Balgrist, Zurich, Switzerland.
• Anesthesiology. 1997 Dec 1;87(6):1343-7.

BackgroundThe authors compared patient-controlled interscalene analgesia (PCIA) with local anesthetics with intravenous patient-controlled analgesia (PCA) with opioids to manage postoperative pain after major shoulder surgery.MethodsForty patients scheduled for elective major shoulder surgery were prospectively randomized to receive either PCIA or PCA. Before surgery, all patients had an interscalene block. In the PCIA group, a catheter was introduced within the interscalene sheath. Six hours after the initial block, patients received for 48 h either a continuous infusion of 0.15% bupivacaine through the interscalene catheter at a rate of 5 ml/h plus a bolus of 3 or 4 ml with a lock-time of 20 min (group PCLA) or a continuous intravenous infusion of nicomorphine at a rate of 0.5 mg/h plus a bolus of 2 or 3 mg with a lock-time of 20 min (group PCA). Pain relief was regularly assessed using a visual analog scale, side effects were noted, and the patients were asked to rate their satisfaction at the end of the study.ResultsPain relief was significantly better controlled in the PCIA group at t = 12 and 18 h (P < 0.05). Vomiting and pruritus were 0 versus 25% and 0 versus 25% for the PCIA and PCA groups, respectively (P < 0.05). Patient satisfaction was greater in the PCIA group (P < 0.05). Time of first bolus administration and paracetamol supplement were similar in both groups.ConclusionsThe use of the PCIA technique was uncomplicated and provided better pain relief than PCA during the first 18 h after operation. The incidence of side effects such as vomiting and pruritus was significantly decreased with the use of PCIA, and patient satisfaction was superior in the PCIA group.

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