Preemptive Local Anesthesia in Ankle Arthroscopy.
BACKGROUND
Complex anesthesia is increasingly used in order to reduce postoperative pain and accelerate rehabilitation. The aim of this study was to evaluate the efficacy and safety of preemptive local anesthesia combined with general or spinal anesthesia in ankle arthroscopy.


METHODS
From January 2014 to February 2016, 80 ankle anterior arthroscopies were performed. Patients were randomly assigned to one of 4 groups, depending on the type of anesthesia: A, general and local preemptive; B, spinal and local preemptive; C, general and placebo; D, spinal and placebo. After general or spinal anesthesia, each patient randomly received an injection of 7 mL of a mixture of local anesthetics or the same amount of normal saline. After 2, 4, 8, 12, 16, 24, 48, and 72 hours following the release of the tourniquet, the pain intensity level was measured with a visual analog scale (VAS). The use of additional analgesics and any adverse effects were also noted.


RESULTS
Preemptive local anesthesia (groups A and B) resulted in a significantly lower level of pain intensity during the first 24 hours after surgery. Until 8 hours after the release of the tourniquet, the pain intensity level was statistically lower in the groups A, B, and D in comparison to C. During hospitalization, none of the patients from groups A and B received on-demand ketoprofen intravenously. No side effects of local anesthetic agents were observed. Two patients had transient numbness and paresthesia in the field of sensory nerve innervation of the dorsal intermediate cutaneous nerve of the foot.


CONCLUSIONS
Preemptive operative site infiltration with a mixture of local anesthetics performed in ankle arthroscopy was a safe procedure. It reduced the level of intensity of postoperative pain and the amount of analgesics used.


METHODS
Level I, prospective randomized study.
Department of Orthopaedics and Rehabilitation, University Hospital in Krakow, Poland.
Henryk
H
Liszka
Department of Orthopaedics and Rehabilitation, University Hospital in Krakow, Poland ortopediasu@gmail.com.|Department of Orthopaedics and Physiotherapy at Jagiellonian University Collegium Medicum, Poland.
Artur
A
Gądek
D000328:Adult; D000768:Anesthesia, General; D000772:Anesthesia, Local; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000842:Ankle; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001182:Arthroscopy; D002045:Bupivacaine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007267:Injections; D007660:Ketoprofen / Q000627:therapeutic use; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*
D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007660:Ketoprofen; D008012:Lidocaine; D002045:Bupivacaine
ankle arthroscopy; local anesthetic infiltration; postoperative pain; preemptive local anesthesia