title: The effect of intraarticular levobupivacaine and bupivacaine injection on the postoperative pain management in total knee artroplastic surgery.
abstract: OBJECTIVE
  Total knee arthroplasty (TKA) is associated with considerable postoperative pain. We compared the effects of intraoperative intraarticular levobupivacaine and bupivacaine on postoperative analgesia and analgesic consumption after total knee arthroplasty.
  
  
  METHODS
  Sixty ASA (American Society of Anesthesiologists) physical status II-III, 18-75 years old patients scheduled for unilateral TKA were included in this study. For the operative procedure combined spinal epidural anesthesia was given by injecting 15mg levobupivacaine in subarachnoid space at L3-4/L4- 5 in sitting position for all patients. In Group L 20ml levobupivacaine(0.5%), in Group B 20ml bupivacaine (0.5%) was injected intraarticularly 10 minutes before opening of the tourniquet at the end of the surgery. For all patients postoperative analgesia was provided with PCEA (levobupivacaine+fentanyl) and oral 1gr paracetamol four times a day. Patients' intraoperative-postoperative hemodynamical data, postoperative sensorial-motor block characteristics, side effects, PCEA demand ratios and bolus volumes, total analgesic consumption, VAS values, first mobilization time, hospitalization time were recorded. Statistical analysis was performed with SPSS version 13.00 software.
  
  
  RESULTS
  There was no intergroup difference in demographic data, hemodynamical data, PCEA demand ratios, total analgesic consumption, first mobilization time, hospitalization time and VAS values at 0,2,72 hour. Postoperative lower VAS values were determined at 4,8,12,24 hours in Group B and at 48(th) hour in Group L(p<0.05).
  
  
  CONCLUSIONS
  Intraarticular local anesthetic administration in addition to PCEA for post operative pain relief provides good analgesia after TKA surgery.
authors: Nurcan Yavuz, MD, Assistant Professor, Department of Anesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey.
authors: Nurcan
authors: N
authors: Yavuz
authors: Vildan Taspinar, MD, Chairman, Department of Anesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey.
authors: Vildan
authors: V
authors: Taspinar
authors: Derya Karasu, MD, Assistant Professor of Anesthesiology and Reanimation, Sevket Yilmaz Training and Research Hospital, Turkey.
authors: Derya
authors: D
authors: Karasu
authors: Aysu Tezcan, MD, Assistant Professor, Department of Anesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey.
authors: Aysu
authors: A
authors: Tezcan
authors: Bayazit Dikmen, MD, Assistant Professor, Department of Anesthesiology and Reanimation, Gazi University Faculty of Medicine, Ankara, Turkey.
authors: Bayazit
authors: B
authors: Dikmen
authors: Nermin Gogus, MD, Chairman, Department of Anesthesiology and Reanimation, Hitit University Faculty of Medicine, Corum, Turkey.
authors: Nermin
authors: N
authors: Gogus
keywords: Intraarticular; Patient controlled epidural analgesia; Postoperative analgesia; Total knee arthroplasty