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Artroskopik ön çapraz bağ rekonstrüksiyonusonrası eklem içi bupivakain enjeksiyonuzamanlamasının ve dren klempi durumununpostoperatif ağrı skoru üzerine etkisi

Year 2015, Volume: 49 Issue: 1, 1 - 5, 19.03.2015
https://doi.org/10.3944/AOTT.2015.14.0294

Abstract

Amaç: Çalışmanın amacı, artroskopik ön çapraz bağ (ÖÇB) rekonstrüksiyonu sonrası eklem içi lokal anestezik uygulamada zamanlama ve dren durumunun ağrı skoru üzerine etkisini incelemektir.

Çalışma planı: Artroskopik ÖÇB rekonstrüksiyonu uygulanan kırk hasta randomize olarak dört gruba ayrıldı. İntra-artiküler anestezik ajan olarak 20 ml bupivakain tercih edildi. Grup I hastalarına operasyondan 20 dakika önce (Preemptive-PE), Grup II hastalarına ameliyattan sonra ve hemovak dren klempi açık bırakılarak (Drain Open-DO), Grup III hastalarına yine ameliyattan sonra fakat dren klempi 1 saat kapalı kalacak şekilde (Drain Closed-DC) eklem içi enjeksiyon uygulanırken, Grup IV hastaları kontrol grubu olarak seçildi ve herhangi bir eklem içi enjeksiyon uygulanmadı (Control Group-CG). Görsel Analog Skalası (Visual analog scale-VAS) ve ek analjezi gereksinimleri kaydedildi.

Bulgular: Postoperatif 2. saatte PE grubu en düşük, CG grubu ise en yüksek VAS skoruna sahipti. 4. saatte sıralama değişmezken, DC grubunun DO grubu hastalar üzerinde ağrı kontrolü bakımından anlamlı üstünlük sağladığı görüldü (p<0.05). Altıncı saatte PE ve DC grupları aralarında anlamlı fark saptanmazken bu iki grubun VAS skorları diğer gruplardan daha düşüktü (p<0.05). 12. saatte PE ve CG grupları, DC ve DO gruplarına kıyasla daha yüksek VAS skorlarına sahip bulundu. 24. saatte grupların VAS skorları arasında fark saptanmadı. İlk analjezik ihtiyacı CG grubunda diğer gruplara kıyasla anlamlı olarak en erken, PE grubunda ise en geç olmuştur (p<0.001).

Çıkarımlar: Operasyonun farklı periyodlarında yapılan eklem içi bupivakain enjeksiyonu, postopera¬tif dönemde değişken VAS skorları sağlamıştır. Enjeksiyon sonrası drenin klemplenmesi, etki süresini kısaltmadan erken analjezi etkisi oluşturmuştur.

References

  • Höher J, Kersten D, Bouillon B, Neugebauer E, Tiling T. Local and intra-articular infiltration of bupivacaine before surgery: effect on postoperative pain after anterior cruciate ligament reconstruction. Arthroscopy 1997;13:210-7.
  • Matheny JM, Hanks GA, Rung GW, Blanda JB, Kalenak A. A comparison of patient-controlled analgesia and con- tinuous lumbar plexus block after anterior cruciate liga- ment reconstruction. Arthroscopy 1993;9:87-90.
  • Alford JW, Fadale PD. Evaluation of postoperative bupiva- caine infusion for pain management after anterior cruciate ligament reconstruction. Arthroscopy 2003;19:855-61.
  • Heard SO, Edwards WT, Ferrari D, Hanna D, Wong PD, Liland A, et al. Analgesic effect of intraarticular bupiva- caine or morphine after arthroscopic knee surgery: a ran- domized, prospective, double-blind study. Anesth Analg 1992;74:822-6.
  • Wulf H, Löwe J, Gnutzmann KH, Steinfeldt T. Femoral nerve block with ropivacaine or bupivacaine in day case anterior crucial ligament reconstruction. Acta Anaesthe- siol Scand 2010;54:414-20.
  • Cobo-Molinos J, Poncela-Garcia M, Marchal-Corrales JA, Delgado-Martinez AD. Effect of levobupivacaine on articular chondrocytes: an in-vitro investigation. Eur J An- aesthesiol. 2014;31:635-9.
  • Hosseini H, Abrisham SM, Jomeh H, Kermani-Algho- raishi M, Ghahramani R, Mozayan MR. The comparison of intraarticular morphine-bupivacaine and tramadol-bu- pivacaine in postoperative analgesia after arthroscopic an- terior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2012;20:1839-44.
  • Chu CR, Izzo NJ, Papas NE, Fu FH. In vitro exposure to 0.5% bupivacaine is cytotoxic to bovine articular chondro- cytes. Arthroscopy 2006;22:693-9.
  • Gomoll AH, Yanke AB, Kang RW, Chubinskaya S, Wil- liams JM, Bach BR, et al. Long-term effects of bupivacaine on cartilage in a rabbit shoulder model. Am J Sports Med 2009;37:72-7.
  • Townshend D, Emmerson K, Jones S, Partington P, Muller S. Intra-articular injection versus portal infiltration of 0.5% bupivacaine following arthroscopy of the knee: a prospective, randomised double-blinded trial. J Bone Joint Surg Br 2009;91:601-3.
  • Elkousy H, Kannan V, Calder CT, Zumwalt J, O’Connor DP, Woods GW. Intra-articular morphine versus bupiva- caine for postoperative pain management. Orthopedics 2013;36:e1121-7.
  • Mitra S, Kaushal H, Gupta RK. Evaluation of analgesic efficacy of intra-articular bupivacaine, bupivacaine plus fentanyl, and bupivacaine plus tramadol after arthroscopic knee surgery. Arthroscopy 2011;27:1637-43.
  • Senthilkumaran S, Tate R, Read JR, Sutherland AG. In- tra-articular morphine and bupivicaine for post-operative analgesia in anterior cruciate ligament reconstruction: a prospective randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 2010;18:731-5.
  • Chirwa SS, MacLeod BA, Day B. Intraarticular bupi- vacaine (Marcaine) after arthroscopic meniscectomy: a randomized double-blind controlled study. Arthroscopy 1989;5:33-5.
  • Bourne MH, Johnson KA. Postoperative pain relief using local anesthetic instillation. Foot Ankle 1988;8:350-1.
  • Tverskoy M, Cozacov C, Ayache M, Bradley EL Jr, Kissin I. Postoperative pain after inguinal herniorrhaphy with dif- ferent types of anesthesia. Anesth Analg 1990;70:29-35.
  • Denti M, Randelli P, Bigoni M, Vitale G, Marino MR, Fraschini N. Pre- and postoperative intra-articular anal- gesia for arthroscopic surgery of the knee and arthrosco- py-assisted anterior cruciate ligament reconstruction. A double-blind randomized, prospective study. Knee Surg Sports Traumatol Arthrosc 1997;5:206-12.
  • Smith I, Van Hemelrijck J, White PF, Shively R. Effects of local anesthesia on recovery after outpatient arthroscopy. Anesth Analg 1991;73:536-9.
  • Joshi GP, McCarroll SM, O’Brien TM, Lenane P. Intraar- ticular analgesia following knee arthroscopy. Anesth Analg 1993;76:333-6.
  • Saunders B, Wing PC. Washout of local anesthetic during arthroscopy. Arthroscopy 1988;4:90-2.
  • Litonius E, Tarkkila P, Neuvonen PJ, Rosenberg PH. Ef- fect of intravenous lipid emulsion on bupivacaine plasma concentration in humans. Anaesthesia 2012;67:600-5.
  • Guler G, Karaoglu S, Akin A, Dogru K, Demir L, Made- noglu H, et al. When to inject analgesic agents intra-articu- larly in anterior cruciate ligament reconstruction: before or after tourniquet releasing. Arthroscopy 2004;20:918-21.
  • Khoury GF, Chen AC, Garland DE, Stein C. Intraarticu- lar morphine, bupivacaine, and morphine/bupivacaine for pain control after knee videoarthroscopy. Anesthesiology 1992;77:263-6.
  • Marchal JM, Delgado-Martinez AD, Poncela M, Valen- zuela J, de Dios Luna J. Does the type of arthroscopic surgery modify the analgesic effect of intraarticular mor- phine and bupivacaine? A preliminary study. Clin J Pain 2003;19:240-6.

Do timing of injection and status of the suction drain effect postoperative pain scores after intra-articular bupivacaine injection in arthroscopic ACL reconstruction?

Year 2015, Volume: 49 Issue: 1, 1 - 5, 19.03.2015
https://doi.org/10.3944/AOTT.2015.14.0294

Abstract

Objective: The aim of this study was to determine if the timing of intra-articular local anesthetic injection and the status of the suction drain affect variable pain scores after ACL reconstruction.

Methods: The study included 40 patients undergoing arthroscopic ACL reconstruction randomized into 4 groups. Patients in Group 1 received intra-articular 20 ml of 0.25% bupivacaine 20 minutes before the start of the operation (preemptive: PE), Group 2 at the end of the operation with the suction drain opened (DO). Group 3 also received intra-articular bupivacaine at the end of the operation and the drain was kept closed for one hour postoperatively (DC). Group 4 did not receive any intraarticular injection (control group: CG) and served as the control group. Visual analog scale (VAS) scores and additional analgesic requirements were recorded.

Results: The PE group had the lowest and the control group the highest VAS scores at the second postoperative hour. At the fourth postoperative hour, VAS scores were significantly higher in the DC group than the DO group (p<0.05). At the sixth postoperative hour, the PE and DC groups had significantly lower VAS scores than the other groups (p<0.05). At Hour 12, the PE and control groups had higher VAS scores than the DO and DC groups. VAS scores were not different among groups at Hour 24. The interval to first analgesic requirement was significantly shorter in the control group and longer in the PE group in comparison to the other two groups (p<0.001).

Conclusion: Intra-articular bupivacaine injection at different stages of the operation yielded variable VAS scores in the postoperative period. Closing the drain after intra-articular injection resulted in an early onset analgesic effect without shortening the duration.

References

  • Höher J, Kersten D, Bouillon B, Neugebauer E, Tiling T. Local and intra-articular infiltration of bupivacaine before surgery: effect on postoperative pain after anterior cruciate ligament reconstruction. Arthroscopy 1997;13:210-7.
  • Matheny JM, Hanks GA, Rung GW, Blanda JB, Kalenak A. A comparison of patient-controlled analgesia and con- tinuous lumbar plexus block after anterior cruciate liga- ment reconstruction. Arthroscopy 1993;9:87-90.
  • Alford JW, Fadale PD. Evaluation of postoperative bupiva- caine infusion for pain management after anterior cruciate ligament reconstruction. Arthroscopy 2003;19:855-61.
  • Heard SO, Edwards WT, Ferrari D, Hanna D, Wong PD, Liland A, et al. Analgesic effect of intraarticular bupiva- caine or morphine after arthroscopic knee surgery: a ran- domized, prospective, double-blind study. Anesth Analg 1992;74:822-6.
  • Wulf H, Löwe J, Gnutzmann KH, Steinfeldt T. Femoral nerve block with ropivacaine or bupivacaine in day case anterior crucial ligament reconstruction. Acta Anaesthe- siol Scand 2010;54:414-20.
  • Cobo-Molinos J, Poncela-Garcia M, Marchal-Corrales JA, Delgado-Martinez AD. Effect of levobupivacaine on articular chondrocytes: an in-vitro investigation. Eur J An- aesthesiol. 2014;31:635-9.
  • Hosseini H, Abrisham SM, Jomeh H, Kermani-Algho- raishi M, Ghahramani R, Mozayan MR. The comparison of intraarticular morphine-bupivacaine and tramadol-bu- pivacaine in postoperative analgesia after arthroscopic an- terior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2012;20:1839-44.
  • Chu CR, Izzo NJ, Papas NE, Fu FH. In vitro exposure to 0.5% bupivacaine is cytotoxic to bovine articular chondro- cytes. Arthroscopy 2006;22:693-9.
  • Gomoll AH, Yanke AB, Kang RW, Chubinskaya S, Wil- liams JM, Bach BR, et al. Long-term effects of bupivacaine on cartilage in a rabbit shoulder model. Am J Sports Med 2009;37:72-7.
  • Townshend D, Emmerson K, Jones S, Partington P, Muller S. Intra-articular injection versus portal infiltration of 0.5% bupivacaine following arthroscopy of the knee: a prospective, randomised double-blinded trial. J Bone Joint Surg Br 2009;91:601-3.
  • Elkousy H, Kannan V, Calder CT, Zumwalt J, O’Connor DP, Woods GW. Intra-articular morphine versus bupiva- caine for postoperative pain management. Orthopedics 2013;36:e1121-7.
  • Mitra S, Kaushal H, Gupta RK. Evaluation of analgesic efficacy of intra-articular bupivacaine, bupivacaine plus fentanyl, and bupivacaine plus tramadol after arthroscopic knee surgery. Arthroscopy 2011;27:1637-43.
  • Senthilkumaran S, Tate R, Read JR, Sutherland AG. In- tra-articular morphine and bupivicaine for post-operative analgesia in anterior cruciate ligament reconstruction: a prospective randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 2010;18:731-5.
  • Chirwa SS, MacLeod BA, Day B. Intraarticular bupi- vacaine (Marcaine) after arthroscopic meniscectomy: a randomized double-blind controlled study. Arthroscopy 1989;5:33-5.
  • Bourne MH, Johnson KA. Postoperative pain relief using local anesthetic instillation. Foot Ankle 1988;8:350-1.
  • Tverskoy M, Cozacov C, Ayache M, Bradley EL Jr, Kissin I. Postoperative pain after inguinal herniorrhaphy with dif- ferent types of anesthesia. Anesth Analg 1990;70:29-35.
  • Denti M, Randelli P, Bigoni M, Vitale G, Marino MR, Fraschini N. Pre- and postoperative intra-articular anal- gesia for arthroscopic surgery of the knee and arthrosco- py-assisted anterior cruciate ligament reconstruction. A double-blind randomized, prospective study. Knee Surg Sports Traumatol Arthrosc 1997;5:206-12.
  • Smith I, Van Hemelrijck J, White PF, Shively R. Effects of local anesthesia on recovery after outpatient arthroscopy. Anesth Analg 1991;73:536-9.
  • Joshi GP, McCarroll SM, O’Brien TM, Lenane P. Intraar- ticular analgesia following knee arthroscopy. Anesth Analg 1993;76:333-6.
  • Saunders B, Wing PC. Washout of local anesthetic during arthroscopy. Arthroscopy 1988;4:90-2.
  • Litonius E, Tarkkila P, Neuvonen PJ, Rosenberg PH. Ef- fect of intravenous lipid emulsion on bupivacaine plasma concentration in humans. Anaesthesia 2012;67:600-5.
  • Guler G, Karaoglu S, Akin A, Dogru K, Demir L, Made- noglu H, et al. When to inject analgesic agents intra-articu- larly in anterior cruciate ligament reconstruction: before or after tourniquet releasing. Arthroscopy 2004;20:918-21.
  • Khoury GF, Chen AC, Garland DE, Stein C. Intraarticu- lar morphine, bupivacaine, and morphine/bupivacaine for pain control after knee videoarthroscopy. Anesthesiology 1992;77:263-6.
  • Marchal JM, Delgado-Martinez AD, Poncela M, Valen- zuela J, de Dios Luna J. Does the type of arthroscopic surgery modify the analgesic effect of intraarticular mor- phine and bupivacaine? A preliminary study. Clin J Pain 2003;19:240-6.
There are 24 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Eren Cansu This is me

Tevfik Balikci This is me

Mustafa Asansu This is me

Selim Ergun This is me

Yakup Yildirim This is me

Publication Date March 19, 2015
Published in Issue Year 2015 Volume: 49 Issue: 1

Cite

APA Cansu, E., Balikci, T., Asansu, M., Ergun, S., et al. (2015). Do timing of injection and status of the suction drain effect postoperative pain scores after intra-articular bupivacaine injection in arthroscopic ACL reconstruction?. Acta Orthopaedica Et Traumatologica Turcica, 49(1), 1-5. https://doi.org/10.3944/AOTT.2015.14.0294
AMA Cansu E, Balikci T, Asansu M, Ergun S, Yildirim Y. Do timing of injection and status of the suction drain effect postoperative pain scores after intra-articular bupivacaine injection in arthroscopic ACL reconstruction?. Acta Orthopaedica et Traumatologica Turcica. March 2015;49(1):1-5. doi:10.3944/AOTT.2015.14.0294
Chicago Cansu, Eren, Tevfik Balikci, Mustafa Asansu, Selim Ergun, and Yakup Yildirim. “Do Timing of Injection and Status of the Suction Drain Effect Postoperative Pain Scores After Intra-Articular Bupivacaine Injection in Arthroscopic ACL Reconstruction?”. Acta Orthopaedica Et Traumatologica Turcica 49, no. 1 (March 2015): 1-5. https://doi.org/10.3944/AOTT.2015.14.0294.
EndNote Cansu E, Balikci T, Asansu M, Ergun S, Yildirim Y (March 1, 2015) Do timing of injection and status of the suction drain effect postoperative pain scores after intra-articular bupivacaine injection in arthroscopic ACL reconstruction?. Acta Orthopaedica et Traumatologica Turcica 49 1 1–5.
IEEE E. Cansu, T. Balikci, M. Asansu, S. Ergun, and Y. Yildirim, “Do timing of injection and status of the suction drain effect postoperative pain scores after intra-articular bupivacaine injection in arthroscopic ACL reconstruction?”, Acta Orthopaedica et Traumatologica Turcica, vol. 49, no. 1, pp. 1–5, 2015, doi: 10.3944/AOTT.2015.14.0294.
ISNAD Cansu, Eren et al. “Do Timing of Injection and Status of the Suction Drain Effect Postoperative Pain Scores After Intra-Articular Bupivacaine Injection in Arthroscopic ACL Reconstruction?”. Acta Orthopaedica et Traumatologica Turcica 49/1 (March 2015), 1-5. https://doi.org/10.3944/AOTT.2015.14.0294.
JAMA Cansu E, Balikci T, Asansu M, Ergun S, Yildirim Y. Do timing of injection and status of the suction drain effect postoperative pain scores after intra-articular bupivacaine injection in arthroscopic ACL reconstruction?. Acta Orthopaedica et Traumatologica Turcica. 2015;49:1–5.
MLA Cansu, Eren et al. “Do Timing of Injection and Status of the Suction Drain Effect Postoperative Pain Scores After Intra-Articular Bupivacaine Injection in Arthroscopic ACL Reconstruction?”. Acta Orthopaedica Et Traumatologica Turcica, vol. 49, no. 1, 2015, pp. 1-5, doi:10.3944/AOTT.2015.14.0294.
Vancouver Cansu E, Balikci T, Asansu M, Ergun S, Yildirim Y. Do timing of injection and status of the suction drain effect postoperative pain scores after intra-articular bupivacaine injection in arthroscopic ACL reconstruction?. Acta Orthopaedica et Traumatologica Turcica. 2015;49(1):1-5.