title: Anesthesia and postoperative analgesia after intra-articular injection of warmed versus room-temperature levobupivacaine: a double-blind randomized trial.
abstract: OBJECTIVE
  This prospective, randomized, blinded study was designed to compare the effects of warmed versus room-temperature levobupivacaine in patients undergoing knee arthroscopy and partial meniscectomy.
  
  
  METHODS
  Patients were randomly allocated into 2 groups of 16 patients each. In all patients the 2 portal sites were infiltrated with 10 mL of room-temperature mepivacaine (20 mg/mL). In the first group, patients underwent intra-articular injection of 20 mL of levobupivacaine (5 mg/mL) and 0.005-mg/mL epinephrine (1:200,000) at a temperature of 40 degrees C +/- 0.2 degrees C, whereas in the second group the levobupivacaine and epinephrine were at room temperature (25 degrees C +/- 0.5 degrees C). Pain was graded and recorded intraoperatively and postoperatively by use of a visual analog scale (VAS). Analgesia was supplemented if the VAS score was 4 cm or greater with morphine intraoperatively or ketorolac postoperatively.
  
  
  RESULTS
  There were no significant differences between groups in intraoperative and postoperative VAS values. There was no need for morphine as a rescue dose in any patient during surgery. Eight patients treated with warmed levobupivacaine and seven patients treated with room-temperature levobupivacaine requested a single rescue dose of ketorolac (30 mg) postoperatively.
  
  
  CONCLUSIONS
  No compelling evidence exists to suggest that intra-articular injection of warmed levobupivacaine is more effective than room-temperature levobupivacaine for intraoperative anesthesia and postoperative analgesia in patients undergoing partial meniscectomy during knee arthroscopy.
  
  
  METHODS
  Level I, randomized controlled trial.
authors.affiliation: Department of Anaesthesia and Intensive Care, Santa Maria degli Angeli Hospital, Pordenone, Italy. Yigal.Leykin@aopn.fvg.it
authors.forename: Yigal
authors.initials: Y
authors.lastname: Leykin
authors.forename: Rachele
authors.initials: R
authors.lastname: Nespolo
authors.forename: Francesca
authors.initials: F
authors.lastname: Foltran
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Burato
authors.forename: Nadia
authors.initials: N
authors.lastname: Noal
authors.forename: Marco
authors.initials: M
authors.lastname: Baciarello
authors.forename: Guido
authors.initials: G
authors.lastname: Fanelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000698:Analgesia / Q000379:methods*; D000758:Anesthesia / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods*; D000077554:Levobupivacaine; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery*; D008619:Mepivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D010147:Pain Measurement; D011184:Postoperative Period; D013696:Temperature; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D000077554:Levobupivacaine; D008619:Mepivacaine; D002045:Bupivacaine; D004837:Epinephrine