title: Effects of intra-articular levobupivacaine, fentanyl-levobupivacaine and tramadol-levobupivacaine for postoperative pain in arthroscopic knee surgery.
abstract: OBJECTIVE
  The aim of this study was to compare the postoperative analgesic efficacy of intra-articularly injected levobupivacaine, levobupivacaine-fentanyl, and levobupivacaine-tramadol combinations.
  
  
  METHODS
  Eighty patients scheduled for elective knee arthroscopy were divided randomly into 4 groups of 20 patients each. Group 1 (the control group) received intra-articular saline, Group 2 received levobupivacaine 2.5 mg/ml, Group 3 received levobupivacaine 2.5 mg/ml + tramadol 50 mg, and Group 4 received levobupivacaine 2.5 mg/ml + fentanyl l50 mcg. All patients were operated on under general anesthesia, and a total of 20 ml study solution was injected: 7 ml subcutaneously before surgery and 13 ml intra-articularly upon completion of surgery. For postoperative, pain visual analogue scale (VAS) was assessed at the 1st, 2nd, 4th, 8th, 12th, and 24th hours postoperatively. Patients with a VAS score over 5 received diclofenac sodium, and the need for rescue analgesics was recorded.
  
  
  RESULTS
  At the 1st, 2nd, 4th, 8th, 12th, and 24th postoperative hours, Group 3 and Group 4 had statistically significant lower VAS scores of pain (p<0.01). Postoperative rescue analgesic requirements were different among the groups. The postoperative 1st hour analgesic requirement was statistically significantly lower in Group 3 and Group 4 when compared to the other groups (p<0.01). At the postoperative 2nd and 4th hours, analgesic requirements were statistically significantly lower in Group 3 than in the other groups (p<0.01). Analgesic requirements were statistically significantly lower in Group 3 and Group 4 than in the other groups (p<0.01). Analgesic requirements at the 12th and 24th postoperative hours did not show any statistically significant difference (p>0.05).
  
  
  CONCLUSIONS
  The results indicated that levobupivacaine combined with either fentanyl or tramadol decreased rescue analgesic requirements when compared to levobupivacaine alone.
authors.affiliation: Şişli Hamidiye Etfal Training and Research Hospital, Department of Anesthesiology and Reanimation, İstanbul, Turkey. drpinaray@yahoo.com.
authors.forename: Pınar
authors.initials: P
authors.lastname: Sayın
authors.affiliation: Şişli Hamidiye Etfal Training and Research Hospital, Department of Anesthesiology and Reanimation, İstanbul, Turkey.
authors.forename: Hale
authors.initials: H
authors.lastname: Dobrucalı
authors.affiliation: Şişli Hamidiye Etfal Training and Research Hospital, Department of Anesthesiology and Reanimation, İstanbul, Turkey.
authors.forename: Hacer Şebnem
authors.initials: HŞ
authors.lastname: Türk
authors.affiliation: Bağcılar Training and Research Hospital, Department of Anesthesiology and Reanimation, İstanbul, Turkey.
authors.forename: Tolga
authors.initials: T
authors.lastname: Totoz
authors.affiliation: Şişli Hamidiye Etfal Training and Research Hospital, Department of Anesthesiology and Reanimation, İstanbul, Turkey.
authors.forename: Canan Tülay
authors.initials: CT
authors.lastname: Işıl
authors.affiliation: Şişli Hamidiye Etfal Training and Research Hospital, Department of Anesthesiology and Reanimation, İstanbul, Turkey.
authors.forename: Ayşe
authors.initials: A
authors.lastname: Hancı
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D001182:Arthroscopy; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D004008:Diclofenac / Q000627:therapeutic use; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000601:surgery*; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011183:Postoperative Complications / Q000188:drug therapy*; D014147:Tramadol / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D004008:Diclofenac; D014147:Tramadol; D000077554:Levobupivacaine; D005283:Fentanyl; D002045:Bupivacaine