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

J Toivonen, V-M Pitko, P H Rosenberg
Acta Anaesthesiologica Scandinavica 2002, 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 patients.

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