Pain relief in day care arthroscopic knee surgery: A comparison between intra-articular ropivacaine and levobupivacaine: A prospective, double-blinded, randomized controlled study

Abstract

Background:Post-operative pain frequently hampers implementation of day care arthroscopic knee surgery in spite of so many analgesic, local anesthetic drugs and routes of administration.Aims:The aim of the present study was carried out to compare the efficacy of ropivacaine and levobupivacaine when administered through intra-articular route in controlling pain after day care arthroscopic knee surgery.Setting and Design:It was a prospective, double-blinded and randomized controlled study.Materials and Methods:April 2008-December 2008, 60 patients of both sex, of American Society of Anesthesiologists physical status I and II, undergoing day care arthroscopic knee surgery were randomly assigned into two groups (R, L). Group R received 10 ml of 0.75% ropivacaine, whereas group L received 10 ml of 0.50% levobupivacaine through intra-articular route at the end of the procedure. Pain assessed using visual analog scale (VAS) and diclofenac sodium given as rescue analgesia when VAS >3. Time of first analgesic request and total rescue analgesic were calculated.Statistical Analysis and Results:based on comparable demographic profiles; time for the requirement of first post-operative rescue analgesia (242.16 ± 23.86 vs. 366.62 ± 24.42) min and total mean rescue analgesic requirement was (104.35 ± 18.96 vs. 76.82 ± 14.28) mg in group R and L respectively. Group R had higher mean VAS score throughout the study period. No side effects found among the groups. These two results were clinically and statistically significant (P < 0.05).Conclusion:Hence, it was evident that intra-articular levobupivacaine give better post-operative pain relief, with an increase in time of first analgesic request and decreased need of total post-operative analgesia compared with ropivacaine.

Knee Arthroplasty Surgery: Comparison of Intra-Articular Levobupivacaine and Dexmedetomidine with Ropivacaine and Dexmedetomidine for Post Operative Pain Management

“…Our study was supported by the study by Das et al Das et al found that intra-articular levobupivacaine increases the duration of analgesia and decreases the need for rescue analgesic in first postoperative 24 hrs. [10] ElHamamsy et al compared inta-articular dexmedetomidine and fentanyl with bupivacaine 0.25% in a volume of 30 ml. They concluded that both dexmedetomidine and fentanyl in combination with bupivacaine resulted in increased time to first analgesic request and decreased the need for postoperative analgesia as well as increased the duration of pain relief as compared with bupivacaine alone.…”

A Comparison Between Intra-Articular 0.2% Ropivacaine and 0.25% Bupivacaine for Post-Operative Analgesia Following Day-Care Arthroscopic Knee Surgeries

“…Intra-articular route of drug administration is an example for the management of pain after joint surgery utilizing the peripheral receptors [3]. Different authors in their previous studies with intraarticular ropivacaine [1,15], fentanyl [16], dexmedetomidine [11], levobupivacaine, and morphine [17] proved their efficacy in providing post-operative analgesia.…”

“…Its association with varying amounts of pain postoperatively, even in less complex procedures such as diagnostic arthroscopy or arthroscopic meniscectomies, is a concern though [1,2]. The hypothesized reason being irritation at the free nerve endings of synovial tissue and anterior pad of fat during surgical excision and resection [3]. Undoubtedly, post-operative pain which is poorly controlled often has an unfavorable impact on the patient's psychology causing discomfort, dissatisfaction, and hampering early ambulation and thus discharges from the hospital [1,4].…”

“…Optimal pain relief in a day-care surgery perioperatively should be adequate and also safe, causing minimal side effect [3,13,14]. Intra-articular route of drug administration is an example for the management of pain after joint surgery utilizing the peripheral receptors [3].…”

“…Peripheral nerve blocks or central blocks [6,7], and not long ago, intra-articular injection of various local anesthetic agents has become popular in clinical practice [2]. Drugs such as ketorolac, α2-agonists [8], opioids [3,9], and local anesthetics [10,11] have been tried to interrupt the pain pathway. Usage of these drugs in combination, called as the multimodal approach, is usually sufficient for providing analgesia in the initial post-operative period [12].…”