Abstract: Comparison between intra-articular bupivacaine with epinephrine and epinephrine alone on short-term and long-term pain after knee arthroscopic surgery under general anesthesia in day-surgery patients.
Toivonen J, Pitko VM, Rosenberg PH.
Department of Anesthesia, South Carelian Central Hospital, Lappeenranta,Finland.
Acta Anaesthesiol Scand. 2002 Apr;46(4):435-40.
BACKGROUND: : Postarthroscopy analgesia has been provided with
intra-articular bupivacaine, but reported results are conflicting
regarding efficacy and the duration of analgesia. The immediate and
long-term effects of intra-articular bupivacaine with epinephrine
after arthroscopic knee surgery were therefore studied in a day
surgery setting. METHODS: : 120 ASA I-II patients scheduled for
arthroscopic knee surgery were given general anesthesia with
spontaneous breathing via a laryngeal mask. In a randomized and
blinded fashion half of them received, at the end of surgery,
intra-articularly 20 mL 0.5% bupivacaine with epinephrine (B +
E-group) and the other half 20 mL saline with epinephrine (S +
E-group). All patients received ketoprofen 100 mg i.v. during
surgery and another 100 mg 2-3 h postoperatively. The patients were
observed for about 4.5 h in the day surgery unit before discharge.
RESULTS: : The results showed that in comparison with the S +
E-group, significantly fewer patients in the B + E-group needed
analgesics (P < 0.0001) and the amount required was also
significantly less postoperatively, before discharge (about 4.5 h
postoperatively) (P < 0.0001). The latency to the need for the
first postoperative analgesic was shorter in the S + E-group
patients (P < 0.0001). At home, during seven days after
discharge, the need for analgesic (oral ketoprofen 100 mg) was
greater in the B + E-group (P < 0.05), especially only during
the second postoperative day, but the visual analoque pain scale
(VAPS) scores were low with no differences between the groups. No
complication occurred. CONCLUSION: : It is concluded that a good
postoperative pain control of intra-articular bupivacaine with
epinephrine was found only in the immediate postoperative period
(i.e. before discharge) in a day-surgery arthroscopic knee surgery
Surgery Orthopaedic Arthroscopy Knee Complications Pain