Журнал «Медицина неотложных состояний» 2 (65) 2015
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Combined intra-articular and portal infiltration with 0,25% bupivacaine after arthroscopic partial medial meniscectomy
Авторы: Tutunnik A.G. - Department of Anaesthesiology and Intensive Care Medicine of Dnepropetrovsk State Medical Academy
Рубрики: Медицина неотложных состояний
Разделы: Клинические исследования
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Background: postoperative pain frequently hampers of day care arthroscopic knee surgery in spite of so many analgesics, local anesthetics and routs of administrations. Both intra-articular and portal infiltration with 0.25% bupivacaine are reported to decrease pain after arthroscopic partial medial meniscectomy. It remains unclear, whether combined anesthesia is effective in lowering pain in motion in order to achieve an early ambulation.
Aims: The aim of the present study was carried out to compare the efficacy of combined of intra-articular and portal infiltration with 0.25% bupivacaine to intra-articular 0.25% bupivacaine alone in controlling pain after arthroscopic partial medial meniscectomy.
Materials and methods: In years 2013-2014, 60 patients of both sex, of American Society of Anesthesiologists physical status I and II, undergoing arthroscopic partial medial meniscectomy were randomly assigned in two groups (I and II). Operations were performed under spinal anesthesia with 1.5 ml of 0.5% bupivacaine. Group I received 20 ml of 0.25% bupivacaine intra-articulary, whereas group II received 20 ml of 0.25% bupivacaine intra-articulary plus 20 ml of 0.25% bupivacaine by portal infiltration. Both groups received ketorolac IM during 24 hours. Pain in motion was assessed by using visual analog scale (VAS) and morphine sulfate as rescue analgesia when VAS>50 mm. Time of first request, patients satisfaction of analgesia were calculated.
Statistical analysis and results: Based on comparable demographic profiles; time for requirement of post-operative analgesia (302.5±10.5 vs 350.2±12.0) min in group I and II respectively. Group I had higher mean VAS score in motion during first 6 hours (30.3±2.3 vs 18.0±2.1) mm. and 12 hours postoperatively (42.2±3.9 vs 32.6±3.1) mm. than in group II respectively . These two results were statistically significant (P<0.05). VAS score at 18 and 24 hours postoperatively were not statistically significant (P>0.05). Analgesic requirement was not different in two groups. Patient`s satisfaction of analgesia was higher in group II.
Conclusion: Hence, it was evident that combined intra-articular and portal infiltration with 0,25% bupivacaine gives better pain relief in motion compared with intra-articular 0,25% bupivacaine alone during the first 12 hours after operation.