Intra-articular ropivacaine 0.75% and bupivacaine 0.50% for analgesia after arthroscopic knee surgery: a randomized prospective study.
OBJECTIVE
Intra-articular administration of local anesthetic solution provides analgesia after arthroscopic knee surgery. Bupivacaine is considered the gold standard local anesthetic in this indication, but ropivacaine, which is less toxic than bupivacaine, can consequently be administered in higher doses, potentially increasing the duration of analgesia. We compared the analgesic effect of intra-articular injection of ropivacaine 225 mg and bupivacaine 150 mg in patients undergoing arthroscopic surgery.


METHODS
Double-blind, randomized prospective clinical study.


METHODS
The study included 45 patients scheduled for knee meniscus repair under arthroscopy, who were allocated randomly into 3 groups to receive, intra-articularly, 30 mL of isotonic saline, bupivacaine 0.5%, or ropivacaine 0.75% solutions at the end of surgery. Postoperatively, pain was measured using a visual analog scale (VAS) at rest and on mobilization. Propacetamol was given when patients complained of pain.


RESULTS
VAS scores at rest and on mobilization were higher in the saline group compared with the ropivacaine group (P = .006 and P = .01, respectively). No difference in VAS scores was documented between bupivacaine and the saline groups. The median delay between the intra-articular administration and propacetamol administration was shorter in the saline group (15 minutes; range, 15 to 120 minutes) compared with the ropivacaine group (240 minutes; range 15 to 720 minutes) but no difference was documented between the bupivacaine group (30 minutes; range, 15 to 360 minutes) and the other 2 groups.


CONCLUSIONS
This level I study documents that intra-articular ropivacaine 0.75% provides better analgesia than bupivacaine 0.5% after knee arthroscopic surgery.


METHODS
Level I.
Marret
Emmanuel
E
Service d'Anesthésie Réanimation, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France.
Gentili
Marc
M
Bonnet
Marie Pierre
MP
Bonnet
Francis
F
D000328:Adult; D000577:Amides / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D018771:Arthralgia / Q000145:classification / Q000188:drug therapy* / Q000209:etiology; D001182:Arthroscopy / Q000009:adverse effects* / Q000379:methods; D002045:Bupivacaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery*; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D000077212:Ropivacaine
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D002045:Bupivacaine