Efficacy of continuous intra-articular bupivacaine infusion for postoperative analgesia after anterior cruciate ligament reconstruction: a double-blinded, placebo-controlled, prospective, and randomized study.
BACKGROUND
The increasing trend toward outpatient surgery has stimulated the development of techniques focused on decreasing perioperative and postoperative pain. Pain control infusion pumps are gaining in popularity in orthopaedic procedures to control postoperative pain.


OBJECTIVE
Continuous infusion of bupivacaine via a catheter placed intra-articular into the knee after anterior cruciate ligament reconstruction using ipsilateral autograft quadrupled semitendinosus will decrease postoperative pain scores and narcotic and NSAID consumption.


METHODS
Randomized controlled trial; Level of evidence, 1.


METHODS
Three randomized study groups of 21 subjects were evaluated: group I, 0.25% bupivacaine infused intra-articular at 4 mL/hour for 72 hours (study); Group II, 0.9% saline infused intra-articular at 4 mL/hr for 72 hours (placebo); Group III, no intra-articular infusion catheter (control). Each subject received general anesthesia and preemptive intra-articular anesthesia. Visual analog scale pain scores and analgesic use were compiled for the 96-hour study period.


RESULTS
With the exception of significantly higher total narcotic usage in the control group compared with the study group only for the time period of 48 to 72 hours, there were no other statistically significant differences between each of the study groups with respect to pain and narcotic and NSAID use for the entire study period.


CONCLUSIONS
The continuous infusion of intra-articular bupivacaine via pain control infusion pumps after anterior cruciate ligament reconstruction using ipsilateral autograft quadrupled semitendinosus cannot be supported when postoperative visual analog scale pain scores and analgesic use are the rationale for justification.
Parker
Richard D
RD
Department of Orthopedic Surgery, Section of Sports Medicine, Cleveland Clinic Sports Health, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. parkerr@ccf.org
Streem
Kathleen
K
Schmitz
Leah
L
Martineau
Paul A
PA
D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D001182:Arthroscopy; D002045:Bupivacaine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D019651:Plastic Surgery Procedures
D000779:Anesthetics, Local; D002045:Bupivacaine