title: Comparison of intraarticular bupivacaine and levobupivacaine with morphine and epinephrine for knee arthroscopy.
abstract: OBJECTIVE
  To compare the efficacy of intraarticularly injected bupivacaine with levobupivacaine when administered in combination with morphine and adrenaline for post-operative analgesia and functional recovery after knee surgery.
  
  
  METHODS
  Sixty American Society of Anesthesiologists physical status I-II patients were randomized into three groups: Group B was administered 30 mL isobaric 0.5% bupivacaine, 2 mg morphine and 100 μg adrenaline, Group L was administered 30 mL 0.5% levobupivacaine, 2 mg morphine and 100 μg adrenaline, and Group C was administered 30 mL 0.9% NaCl solution into the knee joint by the surgeon at the end of surgery. The morphine usage and visual analog pain scores were recorded regularly afterwards. We also recorded the time that elapsed before each patients' first mobilization, positive response to straight leg raising, tolerance to 30-50° knee flexion, recovery of quadriceps reflexes and discharge from the hospital. We also recorded patient and surgeon satisfaction.
  
  
  RESULTS
  The pain scale values were lower in Groups B and L than in Group C at 2, 4, 6, 8, 12 and 24 hours post-operatively (all p<0.001). In Groups B and L, the time for first analgesic request was longer (p<0.01), the morphine consumption was lower (p<0.001), and the duration of morphine usage was shorter (p<0.001). The times to positive response to straight leg raising, tolerance to 30-50° knee flexion and the first mobilization were shorter in Groups B and L (p<0.001 for all).
  
  
  CONCLUSIONS
  After arthroscopic knee surgery, intraarticular levobupivacaine combined with morphine and adrenaline decreases analgesic requirements, shortens the postoperative duration of analgesic use and hastens mobilization as effectively as bupivacaine.
authors.affiliation: Department of Anesthesiology and Reanimation, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: Nurdan
authors.initials: N
authors.lastname: Ozdemir
authors.affiliation: Department of Anesthesiology and Reanimation, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: Fatma Nur
authors.initials: FN
authors.lastname: Kaya
authors.affiliation: Department of Anesthesiology and Reanimation, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: Alp
authors.initials: A
authors.lastname: Gurbet
authors.affiliation: Department of Anesthesiology and Reanimation, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: Aysun
authors.initials: A
authors.lastname: Yilmazlar
authors.affiliation: Department of Orthopedics, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: Burak
authors.initials: B
authors.lastname: Demirag
authors.affiliation: Department of Anesthesiology and Reanimation, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: Bilgen Onbasi
authors.initials: BO
authors.lastname: Mandiraci
keywords: Arthroscopic surgery; bupivacaine; intraarticular injection; levobupivacaine; postoperative pain