Comparison of intra-articular bupivacaine–morphine with bupivacaine–tenoxicam combinations on post-operative analgesia in patients with arthroscopic meniscectomy: a prospective, randomised study

Şanel, Selim; Arpaz, O.; Unay, Koray; Türkmen, İsmail; Şimşek, Selçuk; Uğutmen, Ender

doi:10.1007/s00264-015-2990-5

Cited by 4 publications

(4 citation statements)

References 18 publications

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“… 78 2016 Low Low High High Low Low Sanel et al. 79 2016 Unclear High Low Low Low Low Saritas et al. 80 2015 Low Low High Low Low Low Sayin et al 76 2015 Low Low Low Unclear Unclear High Schwartzberg et al 81 2013 Low Low High Low Low Low Shlaifer et al.…”

Section: Resultsmentioning

confidence: 99%

“…RMX < RM < C, at 24 hours Rescue IV Morphine: RMX < RM, at 24 hours. ∗RM < C, at 24 hours RM: Ropivacaine + morphine mixture PCA of .25% ropivacaine, .2 mg/mL morphine 15 27 ± 3 Control: No drug ‒‒ 15 35 ± 3 Sanel et al., 2016 79 1 Isolated partial meniscectomy Intra-articular injection TEN: tenoxicam with bupivacaine 22 mL of .5% bupivacaine 100 mg + tenoxicam 20 mg, after the surgery and before tourniquet deflation 120 36 VAS and NRS: TEN < MOR, at 12 hours. TEN = MOR, at 1, 2, 4, 6, and 24 hours Total Analgesic: TEN < MOR, at 24 hours MOR: morphine with bupivacaine 22 mL of .5% bupivacaine 100 mg + morphine 2 mg, after the surgery and before tourniquet deflation 120 40 Arti and Mehdinasab, 2011 30 1 ACL reconstruction Intra-articular injection Morphine At end of procedure: 9.5 mL bupivacaine + 5 mg morphine 30 31.5 ± 5.9 VAS: Morphine < all other groups, 0-12 hours after surgery.…”

Section: Resultsmentioning

confidence: 99%

“…Unfortunately, the optimal pain management for meniscectomy is less clear, as several injections provided better outcomes than placebo, but no studies have compared these interventions to determine superiority. 60 , 79 , 93 Providing either 120 mg Etoricoxib and 400 mg Celecoxib preoperatively leads to significant improvements in both pain and opioid consumption for various knee arthroscopy procedures. 63 , 68 , 91 An RCT comparing preoperative Etoricoxib and Celecoxib would help clarify whether one oral medication is superior to the other for knee arthroscopy.…”

Section: Discussionmentioning

confidence: 99%

“…Three studies evaluated injections for meniscectomy. 60,79,93 Sanel et al 79 found that adding 20 mg of tenoxicam to an intra-articular injection with .5% bupivacaine dramatically decreases both pain at 12 hours postoperatively and opioid consumption at 24 hours postoperatively, as opposed to adding 2 mg of morphine with the bupivacaine. However, pain was similar between the groups at 1, 2, 4, 6, and 24 hours postoperatively, so the dramatic difference in pain at 12 hours is not clear.…”

Section: Meniscectomymentioning

confidence: 99%

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Postoperative Multimodal Pain Management and Opioid Consumption in Arthroscopy Clinical Trials: A Systematic Review

Paul

Szukics

Brutico

et al. 2022

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To provide an updated review of multimodal pain management in arthroscopic surgery by evaluating pain and opioid consumption after shoulder, knee, and hip arthroscopy. Methods: A comprehensive literature search was performed to identify randomized controlled trials (RCTs) investigating multimodal pain management after shoulder, knee, and hip arthroscopy. Articles were identified from January 2011 through December 2020 using various databases. As the primary outcome variables of this study, differences in postoperative pain and opioid consumption volumes were summarized from all reported postoperative time points. Results: 37 shoulder, 28 knee, and 8 hip arthroscopy RCTs were included in the study. The most frequent bias present in the included RCTs was incomplete outcome data (58%), while group allocation concealment was the least frequent bias (15%). Qualitative analysis of rotator cuff repair (n ¼ 12), anterior cruciate ligament reconstruction (n ¼ 11), meniscectomy (n ¼ 5), femoroacetabular impingement (n ¼ 2), oral medications (n ¼ 8), postoperative interventions (n ¼ 10), and nonpharmacological interventions (n ¼ 6) was performed. Conclusions: Many multimodal pain management protocols offer improved pain control and decreased opioid consumption after arthroscopic surgery. On the basis of the current literature, the evidence supports an interscalene nerve block with a dexamethasone-dexmedetomidine combination for rotator cuff repair, a proximal continuous adductor canal block for anterior cruciate ligament reconstruction, and local infiltration analgesia (e.g., periacetabular injection with 20 mL of .5% bupivacaine) for hip arthroscopy. When evaluating oral medication, the evidence supports 150 mg Pregabalin for shoulder arthroscopy, 400 mg Celecoxib for knee arthroscopy, and 200 mg Celecoxib for hip arthroscopy, all taken preoperatively. There is promising evidence for the use of various nonpharmacological modalities, specifically preoperative opioid education for rotator cuff repair patients; however, more clinical trials that evaluate nonpharmacological interventions should be performed.

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