Combined pre- and post-surgical bupivacaine would infiltrations decrease opioid requirements after knee ligament reconstruction

Abstract

GENERAL ANESTHESIA 245Purpose: To test the efficacy of a combination of selective pre-and post-surgical local anesthetic infiltrations of the knee, compared with standard intra-articular injection at the end of surgery alone, to reduce postoperative opioid requirements following arthroscopic cruciate ligament reconstruction (ACLR). Methods: In a double-blind, randomized, controlled trial, we studied 23 patients (ASA I or II) scheduled for elective ACLR under general anesthesia. The treatment group (n=12) received infiltrations with bupivacaine 0.25% with epinephrine 1:200 000 presurgically (10 ml into the portals, 10 ml at the medial tibial incision site, 10 ml at the lateral femoral incision site, and 10 ml intra-articularly) and postsurgically (5 ml at the medial tibial incision and 10 ml at the lateral femoral incision). The control group (n=11) received infiltrations with saline 0.9% in the same manner. All patients received a standard intra-articular local anesthetic instillation of the knee (25 ml of bupivacaine 0.25% with epinephrine 1:200 000) at the completion of surgery. Results: Postoperative opioid requirements were lower in the treatment group (5.8 ± 2.9 mg morphine equivalent) than in the control group (13.7 ± 5.8 mg; P=0.008). Treatment patients were ready for discharge approximately 30 min earlier than control patients (P=0.046). There were no adverse events in the treatment group. In the control group, 2/11 patients vomited and a third experienced transient postoperative diaphoresis, dizziness and pallor. Conclusion: We conclude that a combination of selective pre-and post-surgical wound infiltration with bupivacaine 0.25% provides superior analgesia compared with a standard post-surgical intra-articular injection alone.Objectif : Tester l'efficacité d'une combinaison d'infiltrations sélectives du genou, préopératoires et postopéra-toires, avec un anesthésique local, comparée à l'injection intra-articulaire régulière de fin d'intervention seulement, dans le but de réduire les besoins postopératoires d'opioïdes à la suite de la reconstruction arthroscopique du ligament croisé (RALC). Méthode : L'étude randomisée, contrôlée et à double insu a porté sur 23 patients (ASA I ou II) pour qui une RALC avait été prévue sous anesthésie générale. Les patients étudiés (n = 12) ont reçu des infiltrations préchirur-gicales de bupivacaïne à 0,25 % avec de l'épinéphrine à 1:200 000 (10 ml via le portail, 10 ml au site d'incision tibial médian, 10 ml dans l'incision fémorale latérale et 10 ml intra-articulaire) et postchirurgicales (5 ml dans l'incision tibiale médiane et 10 ml dans l'incision fémorale latérale). Les patients témoins (n = 11) ont reçu des infiltrations de solution salée à 0,9 %, administrées de la même manière. Tous les patients ont reçu une instillation anesthésique standard locale dans l'articulation du genou (25 ml de bupivacaïne à 0,25 % avec de l'épinéphrine à 1:200 000) à la fin de l'opération. Résultats : Les patients testés ont demandé moins d'opioïdes postopératoires (5,8 ± 2,9 mg d'équ...

Bupivacaina ou bupivacaina e morfina intra-articular pós reconstrução do LCA

“…20 We opted for its use at the end as in our group of patients the chosen anesthesia was the spinal block.…”

“…Most surveys found in the literature were conducted with general anesthesia 4,6,9,12-14,16,19,20 and we know that spinal anesthesia has a prolonged preemptive analgesia effect of up to 48 hours, fulfilling the role of preventing the central sensibilization and pain amplification in the postoperative period, thus managing to reduce the use of medications in the postoperative period. 1 Heard et al.…”

Femoral block provides superior analgesia compared with intra-articular ropivacaine after anterior cruciate ligament reconstruction

“…After ACL reconstruction, the intra-articular instillation of local anesthetic provided pain control and decreased opioid use in the PACU. 18,19 Excluding the posterior capsule, the knee joint is innervated by the femoral nerve, the largest branch of the lumbar plexus. Several investigators have reported favorable results using FNB for postoperative pain management after open knee surgery and ACL repair, finding it a highly effective form of Fig 1. Analgesic duration was significantly longer in the femoral group than in the intra-articular group.…”

Comparison of epidural, continuous femoral block and intraarticular analgesia after anterior cruciate ligament reconstruction

“…In this regard, in a recent study Butterfield et al . (18) report reduced i.v. analgesic consumption after pre‐ and postincisional bupivacaine wound infiltrations compared with intraarticular instillation of local anesthetics only at the end of surgery.…”