The efficacy of intra-articular ketamine for postoperative analgesia in outpatient arthroscopic surgery.
OBJECTIVE
The purpose of this study was to compare the postoperative analgesic effects of intra-articularly administered ketamine, neostigmine, and bupivacaine after outpatient arthroscopic surgery.


METHODS
Prospective, randomized, double-blind, clinical study.


METHODS
In this study, 60 patients undergoing arthroscopic surgery other than ligament reconstruction were evaluated for postoperative pain. Ketamine, neostigmine, and bupivacaine were administered intra-articularly. The period of effective analgesia, recorded in minutes, was measured between time 0 and first usage of patient-controlled anesthesia (PCA) by the patients. The visual analog scale (VAS) was used to describe the pain level of the patient.


RESULTS
VAS values were lower for the 3 medication groups compared with the placebo at rest and 90 degrees knee flexion. Intra-articular administration of 0.5 mg/kg ketamine provided longer duration of analgesia as defined by the first PCA use time (P <.05). The total amount of pethidine and analgesia time were longer for the 3 medication groups.


CONCLUSIONS
Our basic finding was reduction in postoperative pain and consumption of adequate analgesic drugs with intra-articular ketamine, bupivacaine, or neostigmine use. We have not seen any psychomimetic side effects, particularly as seen with higher doses or systemic use. This study may conclude that intra-articular administration of ketamine provides long-lasting and effective analgesia, similar to neostigmine but less effective than bupivacaine after knee arthroscopy without any adverse effects. LEVEL OF EVEIDENCE: Level I.
Department of Anesthesiology and Reanimation, Hacettepe University, Ankara, Turkey.
Didem
D
Dal
Onur
O
Tetik
Hanife
H
Altunkaya
Ozlem
O
Tetik
Mahmut Nedim
MN
Doral
D000293:Adolescent; D000328:Adult; D000556:Ambulatory Surgical Procedures; D000700:Analgesics / Q000008:administration & dosage* / Q000627:therapeutic use; D000704:Analysis of Variance; D000779:Anesthetics, Local / Q000627:therapeutic use; D001182:Arthroscopy; D002045:Bupivacaine / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007649:Ketamine / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*
D000700:Analgesics; D000779:Anesthetics, Local; D009388:Neostigmine; D007649:Ketamine; D002045:Bupivacaine