Patient-controlled lidocaine analgesia for acromioplasty surgery

Twenty-four consecutive patients undergoing shoulder acromioplasty were given postoperative analgesia with a new method in which a patient-controlled continuous infusion of lidocaine infiltrated the subacromial space. Seventeen of the acromioplasties were done with arthroscopy, whereas 7 were performed with an open procedure. A 2% solution of lidocaine without epinephrine was used for both a continuous dose of 2 cc/h and patient-controlled interval doses of 1 cc administered at 15-minute intervals. The catheter was left in place for 72 hours. We prospectively studied complications, the patient's subjective pain level, the amount of supplementary pain medication used, and serum levels of lidocaine. In addition, we evaluated a control group of 24 patients undergoing acromioplasty by the same surgeon without the use of this method of pain control. No wound complications occurred. No adverse reactions to lidocaine or overdose of lidocaine occurred. Blood levels of lidocaine averaged 0.3 microgram/mL in the 12 patients studied. Subjective pain levels and the amount of supplementary pain medication used were both lower in the group receiving patient-controlled lidocaine analgesia at statistically significant levels (P = .168 measuring subjective pain level, and P = .0212 measuring supplementary pain medication use). Patient-controlled lidocaine analgesia in the subacromial space appears to be a safe method for achieving high levels of pain control in patients undergoing an acromioplasty.