title: Comparison of the analgesic effects of intra-articular injections administered preoperatively and postoperatively in knee arthroscopy.
abstract: Perioperative injection of analgesic agents is widely used for postoperative pain control following knee arthroscopy. This prospective, randomized, double-blind study explored whether a preoperative analgesic injection offered better pain control than a postoperative injection. Patients undergoing knee arthroscopy under general anesthesia were randomized to receive a standardized combination of intra-articular bupivacaine, morphine, and epinephrine administered either 20 minutes prior to incision or at the end of the procedure. Outcome measures included visual analog pain scores at 0, 30, 60, 90, and 120 minutes after the procedure, total recovery room fentanyl consumption, total oral narcotics consumption for the first 24 hours after surgery, and a validated pain and satisfaction instrument. Of the 22 patients enrolled in the study, 21 successfully completed the study protocol. Pain scores, narcotics consumption, and overall patient satisfaction were not significantly different between the two groups. These findings indicate the timing of intra-articular analgesic injections during outpatient knee arthroscopy, either preoperatively or postoperatively, may be at the discretion of the surgeon.
authors.affiliation: Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Goodwin
authors.forename: Richard D
authors.initials: RD
authors.lastname: Parker
mesh_terms: D001182:Arthroscopy / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D017060:Patient Satisfaction; D018373:Peripheral Nervous System Agents / Q000008:administration & dosage*; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies
chemical_list: D018373:Peripheral Nervous System Agents; D009020:Morphine; D002045:Bupivacaine; D004837:Epinephrine