title: When to inject analgesic agents intra-articularly in anterior cruciate ligament reconstruction: before or after tourniquet releasing.
abstract: OBJECTIVE
  To evaluate 2 different applications of an intra-articular (IA) mixture composed of 40 mL 0.25% bupivacaine and 2 mg morphine in anterior cruciate ligament (ACL) reconstructions, before and after tourniquet release.
  
  
  METHODS
  Prospective, double-blind, randomized, clinical trial.
  
  
  METHODS
  Forty patients who underwent ACL reconstruction were prospectively randomized into 2 groups. Group 1 was injected with IA morphine with bupivacaine 10 minutes before tourniquet release. Group 2 was injected with IA morphine with bupivacaine injection after tourniquet release, after a 30-minute period of waiting with closed drainage. Visual analog scale scores were recorded at 10 and 30 minutes and at 1, 2, 4, 8, 12, and 24 hours after surgery. Detailed records were kept of the amount of analgesic drug required.
  
  
  RESULTS
  In pain scores, there was no difference between the 2 groups except for 30 minutes postoperatively (P = .005). The first analgesic requirement time was significantly lower in group 2 (P < .001) and the total amount of opioid used was lower in group 2 (P = .037) than those in group 1. There was no difference between the 2 groups in terms of operation time (P = .484), although there was a significant difference between groups in terms of tourniquet time (P = .024).
  
  
  CONCLUSIONS
  We conclude that IA analgesic injection after tourniquet release is more beneficial to obtain postoperative analgesia in ACL reconstructions than the same injection before tourniquet release.
  
  
  METHODS
  Level I.
authors.affiliation: Department of Anaesthesiology, Erciyes University, Medical Faculty, Kayseri, Turkey.
authors.forename: Gulen
authors.initials: G
authors.lastname: Guler
authors.forename: Sinan
authors.initials: S
authors.lastname: Karaoglu
authors.forename: Aynur
authors.initials: A
authors.lastname: Akin
authors.forename: Kudret
authors.initials: K
authors.lastname: Dogru
authors.forename: Levent
authors.initials: L
authors.lastname: Demir
authors.forename: Halit
authors.initials: H
authors.lastname: Madenoglu
authors.forename: Adem
authors.initials: A
authors.lastname: Boyaci
mesh_terms: D000698:Analgesia / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D002045:Bupivacaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D006801:Humans; D007270:Injections, Intra-Articular; D009020:Morphine / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D013997:Time Factors; D014111:Tourniquets
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine