The pre‐emptive analgesic effect of intra‐articular bupivacaine in arthroscopic knee surgery*

Abstract

Background: The purpose of this study was to determine whether intra‐articular injection of bupivacaine prior to surgery provided better pain control after arthroscopic meniscectomy as compared with post‐operative administration of bupivacaine. Methods: Forty patients of American Society of Anesthesiologists (ASA) class I or II undergoing arthroscopic meniscectomy were assigned in a randomized, double‐blinded manner into two groups: Group I received 20 ml of 2.5 mg/ml bupivacaine without epinephrine 30 min before skin incision and 20 ml of saline immediately after skin closure. Group II received identical injections in reverse order. All patients received total intravenous anesthesia. Post‐operative pain scores were evaluated at 1, 2, 4, 6, 8, 12 and 24 h at rest and movement of the knee, using a 10‐cm visual analog scale (VAS). The time to first analgesic use and 24‐h analgesic consumption were recorded. Results: Pain scores were lower in Group I compared with Group II at 1, 2, 4 and 6 h at rest and on movement (P < 0.05). The time to first analgesic use was longer in Group I, but there was no statistically significant difference in 24‐h analgesic consumption. Conclusion: Intra‐articular bupivacaine administered before surgery provided a statistically significant reduction in post‐operative pain scores compared with post‐operative bupivacaine administration.

Efficacy of Pocket Irrigation With Bupivacaine and Ketorolac in Breast Augmentation

“…Intra-articular injections of analgesics following knee surgery have been shown to reduce requirements for postoperative pain medication and lead to earlier discharge from the hospital. 5,6 The intraperitoneal instillation of local anesthetic has similarly been shown to decrease postoperative pain following laparoscopic cholecystectomy. 7,8 Parker et al 9 were the first to evaluate whether the periprosthetic administration of a local anesthetic was effective in improving patients' postoperative course following subpectoral breast augmentation.…”

Antinociceptive activity of pre- versus post-operative intra-articular bupivacaine in goats undergoing stifle arthrotomy

“…Post‐operatively, there was no longer a significant analgesic effect of pre‐operative bupivacaine. Therefore a prolonged post‐operative benefit, as hypothesized in the beginning of the study and previously shown in humans (Tuncer et al. 2005), could not be demonstrated.…”

“…Despite the clear theoretical benefit of pre‐emptive analgesia (Dahl & Kehlet 1993), contradictory results about the optimal timing of the intra‐articular bupivacaine administration have been reported in humans. Tuncer et al. (2005) demonstrated that pre‐operative administration was superior to post‐operative while Fagan et al.…”

Eficácia analgésica do uso da dextrocetamina intra-articular em pacientes submetidos a artroplastia total do joelho

“…Bupivacaine was tested intra-articularly before and after knee arthroscopy, with better results in controlling pain when administered before surgery, suggesting a preemptive effect 40 . Because ketamine has been reported as effective in controlling postoperative hyperalgesia, it could also be used before the procedure to evaluate a possible preemptive action, as well as pain could be evaluated weeks after surgery to test its effect on chronic pain after surgery.…”