Intraarticular analgesia after arthroscopic knee surgery: comparison of neostigmine, clonidine, tenoxicam, morphine and bupivacaine

Abstract

We conducted a randomized, placebo-controlled, double blinded study to compare the analgesic effects of intraarticular neostigmine, morphine, tenoxicam, clonidine and bupivacaine in 150 patients undergoing arthroscopic knee surgery. General anaesthesia protocol was same in all patients. At the end of the surgical procedure, patients were randomized into six intraarticular groups equally. Group N received 500 mug neostigmine, Group M received 2 mg morphine, Group T received 20 mg tenoxicam, Group C received 1 microg kg(-1) clonidine, Group B received 100 mg bupivacaine and Group S received saline 20 ml. Visual analog scale scores 0, 30 and 60 min and 2, 4, 6, 12, 24, 48 and 72 h, time to first analgesic need, analgesic consumption at 48 h and 72 h and side effects were noted. Demographic and operational parameters were similar in six groups. All study groups provided analgesia when compared with saline group (P<0.05). Duration of analgesia in Group N and C was longer than other groups (P<0.001). Analgesic consumptions of Group N, C and T were lower than other groups (P<0.01). Pain scores during 2 h postoperatively were lower in all study groups than the control group (P<0.001). In Group B, median pain scores were higher than Groups N and C at 0 min and 30 min postoperatively (P<0.001). Side effects were not significantly different among the six groups. We conclude that the most effective drugs that are administered intraarticularly are neostigmine and clonidine among the five drugs we studied. Tenoxicam provided longer analgesia when compared with morphine and bupivacaine, postoperatively.

Postoperative Pain and Other Acute Pain Syndromes

“…337 Neostigmine (0.5 mg) and clonidine (1 µg/kg) as sole analgesics have been demonstrated to be superior to tenoxicam (20 mg), and all three individual agents were superior to either morphine (2 mg) or bupivacaine (100 mg) given alone. 338 Clonidine (1 µg/ kg) coadministered with bupivacaine provided greater analgesic benefit than did either agent used alone. The combination of clonidine (150 µg) and neostigmine (0.5 mg) was no more effective than either agent given alone, but all intra-articular treatment groups had lower pain scores than did the intra-articular placebo group.…”

Postoperative Pain and Other Acute Pain Syndromes

“…232 Neostigmine (0.5 mg) and clonidine (1 µg/kg) as sole analgesics have been shown to be superior to tenoxicam (20 mg), and all three single agents were superior to the single agents morphine (2 mg) and bupivacaine (100 mg). 225 Clonidine (1 µg/kg) coadministered with bupivacaine has improved analgesic benefi ts when compared with either agent used alone. 233 The combination of clonidine (150 µg) and neostigmine (0.5 mg) was no more effective than either agent given alone, but all intra-articular treatment groups had lower pain scores than did intra-articular placebo groups.…”

“…223 Tenoxicam 20 mg has been used successfully both as a sole intra-articular analgesic and as an adjunct in combination therapy. [224][225][226][227][228][229][230] Intra-articular Neostigmine and Clonidine. Neostigmine (0.5 mg intra-articularly) was shown by Yang and colleagues to be more effi cacious than morphine 2 mg. 231 Neostigmine (0.5 mg) has not been shown to increase postoperative nausea/vomiting when given intra-articularly.…”

Arthroscopy of the Knee; Impact of Intraarticular Pain Management

“…[1][2][3] This study conducted over a period of 2 years, included all patients undergoing knee arthroscopy, irrespective of age, gender and underlying conditions (whether traumatic, degenerative, infective or inflammatory). Patients with Septic Arthritis were not included.…”

“…In this study the impact of postoperative pain management on patient recovery was evaluated. There is evidence that the knee joint has morphine receptors (Alagol et al 2005 Al Otaibi. 2013).…”