title: Intraarticular levobupivacaine or bupivacaine administration decreases pain scores and provides a better recovery after total knee arthroplasty.
abstract: OBJECTIVE
  The aim of this prospective randomized blinded controlled study was to compare the efficacy of the two local anesthetics, intraarticular bupivacaine and levobupivacaine administration, versus control for postoperative pain control and functional recovery. Length of hospital stay, opioid consumption, and the side effects of opioids were also evaluated.
  
  
  METHODS
  Sixty patients of American Society of Anesthesiologists class I-III undergoing elective knee arthroplasty under spinal anesthesia were randomized into three groups. Groups B (n = 20) and L (n = 20) both received 150 ml solution intraarticularly, containing 200 mg bupivacaine or 200 mg levobupivacaine combined with 0.5 mg epinephrine, respectively, at the end of the surgery. Group C (n = 20) received 150 ml saline intraarticularly. Postoperatively, all groups received injections through the intraarticular catheters in quantities of 120 mg (levobupivacaine for group L, bupivacaine for group B) and 0.5 mg epinephrine whereas group C received a saline bolus at 10 and 22 h. Patients were given tramadol by intravenous patient-controlled analgesia (PCA), and sodium diclofenac 75 mg intramuscularly was used for rescue analgesic medication. Visual analogue score (VAS) for pain at rest and during mobilization (which was defined as flexion exercise supported by physiotherapist in postoperative first 8 h and afterward a 3-m walk with walker), consumption of tramadol, side effects, and patient satisfaction were recorded until the 48th hour postoperatively.
  
  
  RESULTS
  Area under the curve values for VAS were lower in groups B and L compared to the control, both at rest and during mobilization (first 48 h) (P = 0.032 and P = 0.029, respectively). Tramadol consumption was lower (P < 0.05), patient satisfaction as evaluated with a five-point Likert score (completely comfortable; quite comfortable; slight discomfort; painful; very painful) was higher (P = 0.03), and length of hospital stay was shorter (P = 0.03) in groups B and L compared to group C.
  
  
  CONCLUSIONS
  Intraarticular bupivacaine and levobupivacaine provided better postoperative analgesia both at rest and during mobilization in total knee replacement surgery compared to control. Tramadol consumption and hospital stay were also decreased in the study groups.
authors.affiliation: Department of Anesthesiology and Reanimation, Ufuk University Faculty of Medicine, Mevlana Bulvarı (Konya Yolu) No: 86-88 Balgat, 06520 Ankara, Turkey. kazakzuleyha@yahoo.com
authors.forename: Zuleyha
authors.initials: Z
authors.lastname: Kazak Bengisun
authors.forename: E
authors.initials: E
authors.lastname: Aysu Salviz
authors.forename: Kamil
authors.initials: K
authors.lastname: Darcin
authors.forename: Hikmet
authors.initials: H
authors.lastname: Suer
authors.forename: Yesim
authors.initials: Y
authors.lastname: Ates
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000627:therapeutic use*; D019540:Area Under Curve; D019645:Arthroplasty, Replacement, Knee; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007902:Length of Stay; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011446:Prospective Studies; D018401:Sample Size; D014147:Tramadol / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D014147:Tramadol; D000077554:Levobupivacaine; D002045:Bupivacaine