title: 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.
abstract: 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.
  
  
  CONCLUSIONS
  : 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.
authors.affiliation: Department of Anesthesia, South Carelian Central Hospital, Lappeenranta, Finland. juhani.toivonen@ekshp.fi
authors.forename: J
authors.initials: J
authors.lastname: Toivonen
authors.forename: V-M
authors.initials: VM
authors.lastname: Pitko
authors.forename: P H
authors.initials: PH
authors.lastname: Rosenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D001182:Arthroscopy; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D002045:Bupivacaine; D004837:Epinephrine