Analgesics effect of intra-articular bupivacaine injection on pain score in anterior cruciate ligament surgery: a randomized clinical trial

Öz

Objective: The aim of this study was to examine the effects of injection timing and drainage clamps on patient pain scores in intra-articular local anesthetic applications after arthroscopic anterior cruciate ligament (ACL) reconstruction. Method: Forty patients undergoing arthroscopic ACL reconstruction were randomly allocated to one of the four study groups according to the time of the intraarticular bupivacaine (20 ml) injection and the presence of the drainage clamps as follows: Preoperative injection group (PO) received bupivacaine injection 20 minutes prior to the operation, Drain Open group (DO) received bupivacaine injection following the operation while the hemovac drain was open, Drain closed group (DC) received bupivacaine injection following the operation while the hemovac drain was closed, and the control group in which the subjects did not receive any intraarticular injections. Results: The VAS score for postoperative joint pain was lowest in PO group among all groups at the postoperative 2nd hour. At the 4th and the 6th postoperative hours the VAS score for postoperative joint pain was similar in the PO and DC groups and was lower than that of the DO group and the controls. However, the VAS score at the postoperative 12th hour was lower in DO and DC groups that the PO group and the controls. Conclusion: The VAS score for postoperative joint pain changes with respect to the timing of the injection and the presence or absence of drainage

Anahtar Kelimeler

• intra-articular,bupivacaine,postoperative pain scores

Kaynakça

1. 1. 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: The Journal of Arthroscopic & Related Surgery. 1997;13(2):210-7.
2. 2. Alford JW, Fadale PD. Evaluation of postoperative bupivacaine infusion for pain management after anterior cruciate ligament reconstruction. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2003;19(8):855-61.
3. 3. Cobo-Molinos J, Poncela-Garcia M, Marchal-Corrales JA, Delgado-Martinez AD. Effect of levobupivacaine on articular chondrocytes: an in-vitro investigation. European Journal of Anaesthesiology (EJA). 2014;31(11):635-9.
4. 4. Hosseini H, Abrisham SMJ, Jomeh H, Kermani-Alghoraishi M, Ghahramani R, Mozayan MR. The comparison of intraarticular morphine–bupivacaine and tramadol–bupivacaine in postoperative analgesia after arthroscopic anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2012;20(9):1839-44.
5. 5. Chu C, Izzo N, Papas N. FU FH. vitro exposure to 05% bupivacaine is cytotoxic to bovine articular chondrocytes. 2006:693-9.
6. 6. Gomoll AH, Yanke AB, Kang RW, Chubinskaya S, Williams JM, Bach BR, et al. Long-term effects of bupivacaine on cartilage in a rabbit shoulder model. The American journal of sports medicine. 2009;37(1):72-7.
7. 7. Chirwa S, MacLeod B, Day B. Intraarticular bupivacaine (Marcaine) after arthroscopic meniscectomy: a randomized double-blind controlled study. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 1989;5(1):33-5.
8. 8. Tverskoy M, Cozacov C, Ayache M, Bradley JE, Kissin I. Postoperative pain after inguinal herniorrhaphy with different types of anesthesia. Anesthesia and Analgesia. 1990;70(1):29-35.

9. 9. Smith I, Van JH, White PF, Shively R. Effects of local anesthesia on recovery after outpatient arthroscopy. Anesthesia and analgesia. 1991;73(5):536-9.
10. 10. Denti M, Randelli P, Bigoni M, Vitale G, Marino M, Fraschini N. Pre-and postoperative intra-articular analgesia for arthroscopic surgery of the knee and arthroscopy-assisted anterior cruciate ligament reconstruction A double-blind randomized, prospective study. Knee Surgery, Sports Traumatology, Arthroscopy. 1997;5(4):206-12.
11. 11. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behavior research methods. 2009;41(4):1149-60.
12. 12. Joshi G, McCarroll S, O'Brien T, Lenane P. Intraarticular analgesia following knee arthroscopy. Anesthesia & Analgesia. 1993;76(2):333-6.
13. 13. Guler G, Karaoglu S, Akin A, Dogru K, Demir L, Madenoglu H, et al. When to inject analgesic agents intra-articularly in anterior cruciate ligament reconstruction: before or after tourniquet releasing. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2004;20(9):918-21.
14. 14. Marchal JM, Delgado-Martinez AD, Poncela M, Valenzuela J, de Dios Luna J. Does the type of arthroscopic surgery modify the analgesic effect of intraarticular morphine and bupivacaine? A preliminary study. The Clinical journal of pain. 2003;19(4):240-6.