title: Intra-articular injection versus portal infiltration of 0.5% bupivacaine following arthroscopy of the knee: a prospective, randomised double-blinded trial.
abstract: The administration of intra-articular local anaesthetic is common following arthroscopy of the knee. However, recent evidence has suggested that bupivacaine may be harmful to articular cartilage. This study aimed to establish whether infiltration of bupivacaine around the portals is as effective as intra-articular injection. We randomised 137 patients to receive either 20 ml 0.5% bupivacaine introduced into the joint (group 1) or 20 ml 0.5% bupivacaine infiltrated only around the portals (group 2) following arthroscopy. A visual analogue scale was administered one hour post-operatively to assess pain relief. Both patients and observers were blinded to the treatment group. A power calculation was performed. The mean visual analogue score was 3.24 (sd 2.20) in group I and 3.04 (sd 2.31) in group 2. This difference was not statistically significant (p = 0.62). Infiltration of bupivacaine around the portals had an equivalent effect on pain scores at one hour, and we would therefore recommend this technique to avoid the possible chondrotoxic effect of intra-articular bupivacaine.
authors.affiliation: Department of Orthopaedics, Wansbeck General Hospital, Woodhorn Lane, Ashington, Northumberland, UK. davetownshend@hotmail.com
authors.forename: D
authors.initials: D
authors.lastname: Townshend
authors.forename: K
authors.initials: K
authors.lastname: Emmerson
authors.forename: S
authors.initials: S
authors.lastname: Jones
authors.forename: P
authors.initials: P
authors.lastname: Partington
authors.forename: S
authors.initials: S
authors.lastname: Muller
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D001182:Arthroscopy / Q000379:methods; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007279:Injections, Subcutaneous; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine