Effects of intraarticular ketamine combined with periarticular bupivacaine on postoperative pain after arthroscopic meniscectomy

Abstract

Objectives This study aims to evaluate the effects of two different doses of intraarticular ketamine on visual analog scale (VAS) scores at rest and movement, time to first analgesic requirement, and 24-h morphine consumption in patients undergoing arthroscopic meniscectomy as well as to assess the frequency of postoperative nausea&vomiting, respiratory depression, pruritus, urinary retention, and constipation and to compare the time to discharge. Patients and methods This prospective randomized double- blind study was performed between August 2013 and August 2014 on 75 patients (32 males, 43 females; mean age 46.7±13 years; range, 18 to 75 years) with American Society of Anesthesiologists scores of I-II scheduled for unilateral meniscectomy. Patients were randomized to receive 0.5 mg.kg -1 ketamine (group K1), 1 mg.kg -1 ketamine (group K2) or saline (group S) to a total volume of 20 mL intraarticularly at the end of the surgery. All patients were performed periarticular 10 mL 0.5% bupivacaine infiltration. Visual analog scale at rest and during passive knee movement was used to evaluate pain both preoperatively and at postoperative 0, 30 min, and 1, 2, 4, 6, 12, and 24 h. Time to first analgesic requirement and morphine consumption were recorded. Results Visual analog scale scores at rest and during movement at postoperative 0 were significantly reduced in group K2 compared with group S (p<0.05). The first analgesic requirement time was significantly longer in group K1 (76.9±25.2 min) and group K2 (93.4±26.1 min) than group S (29.3±7.1 min). Morphine consumption was lower in group K2 compared to group K1 and group S at postoperative 30 min, and 1 and 2 h. However, 24-h morphine consumption was similar in all groups. Conclusion Intraarticular injection of 0.5 mg.kg -1 and 1 mg.kg -1 ketamine for postoperative pain management provided similar analgesic efficacy. However, high dose ketamine more noticeably decreased opioid requirement in the early postoperative period.

Ketamine Supplementation To Bupivacaine For Knee Arthroscopy: A Meta-Analysis of Randomized Controlled Trials

“…The results reveals that ketamine supplementation to bupivacaine can signi cantly reduce the pain scores at 30 min and number of additional analgesics after knee arthroscopy, but showed no obvious impact on pain scores at 1 h, pain scores at 6 h, time of rst analgesic requirement or additional analgesic consumption. In addition, one RCT reported the similar incidence of adverse events such as postoperative nausea and vomiting, urinary retention and pruritus [15].…”

“…132 potentially relevant articles are identi ed initially. Finally, four RCTs that meet our inclusion criteria are included in the meta-analysis [15][16][17]23].…”

“…The three studies are published between 2001 and 2020, and total sample size is 172. Among the four studies included here, two studies report pain scores at 30 min [17,23], two studies report number of additional analgesics [15,23], three studies report pain scores at 1 h [16,17,23], two studies report pain scores at 6 h [17,23], three studies report time of rst analgesic requirement [15][16][17], and two studies report additional analgesic consumption [17,23]. Jadad scores of the four included studies vary from 3 to 5, and all four studies are considered to be high-quality ones according to quality assessment.…”

“…Considering the sensitivity analysis, although there is no signi cant heterogeneity, several factors may result in some bias. Firstly, different administration routes are included, such as intraarticular [15,17] and intravenous [16,23] approaches. Secondly, the doses of ketamine range from 0.15 mg/kg to 1.0 mg/kg, which may affect the e cacy assessment.…”

“…The addition ketamine to bupivacaine for the pain management of knee arthroscopy has not been well established, and several studies reported the con icting results [15][16][17]. With accumulating evidence, we therefore perform a systematic review and meta-analysis of RCTs to explore the e cacy and safety of ketamine supplementation to bupivacaine in patients with knee arthroscopy.…”