Subacromial Catheter After Cuff Repair
We cannot recommend for or against the use of an indwelling subacromial infusion catheter for pain management after rotator cuff repair.
Rationale
Post-operative pain control is an important objective for improving the patient’s overall surgical experience. For this recommendation, we only considered studies of indwelling infusion catheters for the management of pain after rotator cuff repair. We did not consider evidence related to possible benefits of infusion catheters after shoulder procedures without rotator cuff repair.
One Level II study117 compared intravenous injection of fentanyl and ketorolac tromethamine with subacromial infusion of bupivacaine up to 120 hours after rotator cuff repair. There was no statistically significant difference in pain measured by visual analog score between the two groups. Impact on long term clinical outcome was not measured. The authors did not compare these treatments against a clinically-relevant control group (for example oral analgesic medications only). It is not possible to extrapolate the findings of this study to typical clinical situations, since intravenous fentanyl and ketorolac are not routinely used in general orthopaedic practice. Therefore, we can not provide specific recommendations about the use of subacromial indwelling infusion catheters, particularly in the setting of outpatient rotator cuff repair. The work group did not consider risks or benefits of infusion catheter utilization in other clinical conditions.
One Level II study117 compared intravenous injection of fentanyl and ketorolac tromethamine with subacromial infusion of bupivacaine up to 120 hours after rotator cuff repair. There was no statistically significant difference in pain measured by visual analog score between the two groups. Impact on long term clinical outcome was not measured. The authors did not compare these treatments against a clinically-relevant control group (for example oral analgesic medications only). It is not possible to extrapolate the findings of this study to typical clinical situations, since intravenous fentanyl and ketorolac are not routinely used in general orthopaedic practice. Therefore, we can not provide specific recommendations about the use of subacromial indwelling infusion catheters, particularly in the setting of outpatient rotator cuff repair. The work group did not consider risks or benefits of infusion catheter utilization in other clinical conditions.