Efficacy of intra-articular bupivacaine, ropivacaine, or a combination of ropivacaine, morphine, and ketorolac on postoperative pain relief after ambulatory arthroscopic knee surgery: a randomized double-blind study.
BACKGROUND
Effective pain relief is important after diagnostic and therapeutic arthroscopic knee surgery to permit early discharge and improve comfort and mobility at home. The aim of this study was to assess the efficacy of bupivacaine, ropivacaine, or a combination of ropivacaine, morphine, and ketorolac injected intra-articularly for postoperative pain relief after arthroscopic knee surgery.


METHODS
Sixty-three healthy patients undergoing knee arthroscopy under local anesthesia (LA) were randomized to receive 1 of the following substances intra-articularly postoperatively: group B: 30 mL of bupivacaine (150 mg); group R: 30 mL of ropivacaine (150 mg); and group RMK: ropivacaine 150 mg, morphine 4 mg, and ketorolac 30 mg in normal saline (total volume 30 mL). Oral paracetamol 1g and tramadol 50 mg were used as rescue drugs. Postoperatively, pain was assessed at rest and movement, and side effects were recorded. The patients were asked to self-assess pain for 7 days and record analgesic consumption as well as activities of daily living (ADLs). Plasma concentration of LA was measured in another 8 patients.


RESULTS
All groups had excellent analgesia at 0 and 4 hours postoperatively. Group RMK had significantly lower visual analog pain score at rest at 8 hours and during movement at 8 and 24 hours compared with the other groups (P<.05). Group RMK required less paracetamol and tramadol on day 1 (P<.05), had less sleep disturbances because of pain, more patients were ready to work on days 1 and 2 (P<.05), and were more satisfied on days 1 and 4 to 7. Postoperatively, plasma concentrations of ropivacaine and lidocaine were far below known systemic toxic concentrations in all patients.


CONCLUSIONS
Addition of morphine and ketolorac to ropivacaine intra-articularly enhances analgesic efficacy of LA, reduces postdischarge analgesic consumption, and improves ADLs without increasing side effects after ambulatory arthroscopic knee surgery.
Ng
Huey-Ping
HP
Department of Anaesthesiology, University Hospital, Orebro, Sweden.
Nordström
Ulf
U
Axelsson
Kjell
K
Perniola
Andrea Davide
AD
Gustav
Ekbäck
E
Ryttberg
Lars
L
Gupta
Anil
A
D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000553:Ambulatory Care; D000577:Amides / Q000097:blood / Q000627:therapeutic use*; D001182:Arthroscopy; D002045:Bupivacaine / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D020910:Ketorolac / Q000627:therapeutic use*; D007719:Knee Joint / Q000601:surgery; D008012:Lidocaine / Q000097:blood / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D011537:Pruritus / Q000517:prevention & control; D000077212:Ropivacaine; D018689:Sensory System Agents / Q000097:blood / Q000627:therapeutic use*; D012893:Sleep Wake Disorders / Q000188:drug therapy; D011795:Surveys and Questionnaires; D014147:Tramadol / Q000627:therapeutic use
D000577:Amides; D018689:Sensory System Agents; D000082:Acetaminophen; D014147:Tramadol; D009020:Morphine; D000077212:Ropivacaine; D008012:Lidocaine; D002045:Bupivacaine; D020910:Ketorolac