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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
Author(s) -
Toivonen J.,
Pitko V.M.,
Rosenberg P. H.
Publication year - 2002
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1034/j.1399-6576.2002.460418.x
Subject(s) - medicine , bupivacaine , anesthesia , epinephrine , analgesic , surgery , ketoprofen , visual analogue scale , saline , local anesthetic , pharmacology
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.