The effects of intra-articular levobupivacain versus levobupivacain plus magnesium sulfate on postoperative analgesia in patients undergoing arthroscopic meniscectomy: A prospective randomized controlled study

Abstract

ObjectiveThe aim of this study was to compared the effectiveness of intraarticular levobupivacain with levobupivacain and magnesium sulfate.MethodsIn this prospective randomized double blinded study, 96 patients (67 male, 29 female; age range: 18–65 years) with ASA (American Society of Anesthesiologist) score I and II, who had undergone arthroscopic meniscectomy operation, were divided to 3 groups that had postoperative analgesia with intra-articular saline injection (control group), levobupivacain injection (L group) or levobupivacain and magnesium sulfate injection (LM group). Patients were compared with postoperative VAS (Visual Analog Score) score during rest and activity, opioid analgesic need, non-opioid analgesic need and other medication needs.ResultsPostoperative VAS scores during rest and activation at early postoperative period were significantly lower at LM group when compared with L group and lower than control group at all time periods. Opioid analgesic need, non-opioid analgesic need and other medication needs for non-pain symptoms were lower at LM group when compared with L and control groups at all time periods.ConclusionIntraarticular magnesium sulfate plus Levobupivacain injection is a safe and effective method for post operative pain management after arthroscopic meniscectomy.Keywords: Intra-articular injection, Magnesium sulfate, Levobupivacain, Postoperative analgesia, Chondrocyte apoptosis, Pain management, Arthroscopic menisectomyLevel of EvidenceLevel I, Therapeutic study

Comparison of tramadol/acetaminophen fixed-dose combination, tramadol, and acetaminophen in patients undergoing ambulatory arthroscopic meniscectomy

“… 6 , 7 , 8 , 9 , 10 Among the medications used are local anesthetics, non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, opioid, gabapentinoids and magnesium sulfate alone or in combination with local anesthetics. 11 , 12 , 13 In preemptive analgesia, the agents can be used either alone or in combination to increase the analgesic effect via different mechanisms and to reduce the incidence of side effects. 8 , 14 This approach increases postoperative patient satisfaction, while minimizing systemic narcotic use and reducing the undesirable side effects of narcotics, such as nausea, vomiting, sedation, and respiratory depression.…”

Comparison of efficacy of intra-articular plain bupivacaine and bupivacaine with adjuvants (dexmedetomidine and magnesium sulfate) for postoperative analgesia in arthroscopic knee surgeries: A prospective, randomized controlled trial

“…The synergistic action of Mg with levobupivacaine and anti-inflammatory effect of Mg may have contributed to the quality of analgesia with the combination. [ 25 ] Farouk and Aly compared IA Mg (150 mg) and morphine (2 mg) with bupivacaine when used alone and in combination after arthroscopic meniscectomy. [ 26 ] The duration to first analgesic request was significantly longer with morphine, Mg, and bupivacaine combination (947 ± 194 min) than Mg–bupivacaine combination (610 ± 154 min), bupivacaine–morphine combination (645 ± 168 min), or bupivacaine (320 ± 105 min) alone.…”

The effect of magnesium added to bupivacaine for arthroscopy: a meta-analysis of randomized controlled trials

“…Bupivacaine was commonly used for the analgesia of arthroscopy [ 12 , 14 ]. Magnesium sulfate acts as an NMDA (N-Methyl-D-Aspartate) receptor antagonist, and was found to improve the pain management after arthroscopic meniscectomy when added to levobupivacaine [ 15 ].…”

“…Several studies reported the magnesium sulfate plus bupivacaine versus bupivacaine for arthroscopic surgery, but their efficacy has not been well established [ 15 – 18 ]. With accumulating evidence, we therefore perform a systematic review and meta-analysis of RCTs to compare the analgesic efficacy of magnesium sulfate plus bupivacaine versus bupivacaine for arthroscopy.…”