Diclofenac premedication but not intra-articular ropivacaine alleviates pain following day-case knee arthroscopy.
OBJECTIVE
To compare the postoperative analgesic effects of 50 mg diclofenac p.o. before surgery and intra-articular ropivacaine injected after diagnostic day-case knee arthroscopy performed under spinal anesthesia.


METHODS
In a randomized, double-blind investigation, 200 ASA physical status 1-2 outpatients, age 18-60 yr, received either 50 mg diclofenac p.o. or placebo one hour before operation (100 patients per group), and intraarticular injections of either 20 ml of ropivacaine 0.5% or 20 ml of saline 0.9% (50 patients in each premedication groups). Patients received 50 mg diclofenac p.o. prn and, if needed, 0.1 mg x kg(-1) oxycodone im for postoperative pain relief. Patients were discharged home with a supply of 50 mg diclofenac tablets and were given a sheet of paper with knee pain VAS scales and a questionnaire of analgesics taken. Patients rated their VAS scores eight hours after surgery and in the moming and at the end of the first and the second postoperative days, respectively.


RESULTS
The only statistically significant difference was found when the diclofenac groups were combined and compared with the combined placebo premedication groups. The VAS scores of knee pain at eight hours after the operation were 19+/-22 in the two diclofenac premedication groups and 32+/-28 in the two placebo groups (P = 0.001).


CONCLUSIONS
Diclofenac premedication p.o. reduced the VAS scores at eight hours postoperatively while intra-articular ropivacaine did not.
Rautoma
P
P
Department of Anesthesia, Helsinki City Hospital, Finland. rautoma@dlc.fi
Santanen
U
U
Avela
R
R
Luurila
H
H
Perhoniemi
V
V
Erkola
O
O
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000556:Ambulatory Surgical Procedures; D000577:Amides / Q000008:administration & dosage*; D000698:Analgesia; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000704:Analysis of Variance; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D001182:Arthroscopy; D004008:Diclofenac / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005500:Follow-Up Studies; D006801:Humans; D007270:Injections, Intra-Articular; D007273:Injections, Intramuscular; D007719:Knee Joint / Q000601:surgery*; D008875:Middle Aged; D010098:Oxycodone / Q000008:administration & dosage / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D010919:Placebos; D011292:Premedication; D000077212:Ropivacaine
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D010919:Placebos; D004008:Diclofenac; D000077212:Ropivacaine; D010098:Oxycodone