A COMPARISON BETWEEN INTRA-ARTICULAR 0.2% ROPIVACAINE AND 0.25% BUPIVACAINE FOR POST-OPERATIVE ANALGESIA FOLLOWING DAY-CARE ARTHROSCOPIC KNEE SURGERIES

Authors

  • Sai Kaushik P H Department of Anaesthesiology, Kasturba Medical College, Mangalore, Manipal University, Manipal, Karnataka, India.
  • Shaila S Kamath Department of Anaesthesiology, Kasturba Medical College, Mangalore, Manipal University, Manipal, Karnataka, India.
  • Surendra U Kaminuath Department of Orthopaedics, Kasturba Medical College, Mangalore, Manipal University, Manipal, Karnataka, India.

DOI:

https://doi.org/10.22159/ajpcr.2018.v11i2.23200

Keywords:

Surgical pain, Local anesthetic, Analgesia

Abstract

 Objectives: The objective is to compare the effectiveness of intra-articular injection of ropivacaine and bupivacaine in providing pain relief after arthroscopic knee surgery.

Methods: A total of 60 patients of both genders aged 20–60 years, the American Society of Anesthesiologists physical Status I and II, undergoing day-care arthroscopic knee surgery under spinal anesthesia, were assigned into two groups randomly. Group 1 received 10 ml of 0.2% ropivacaine, while Group 2 received 10 ml of 0.25% bupivacaine intra-articularly at the end of the procedure. Pain was assessed for 24 h postoperatively 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 noted and compared. Statistical analysis used: Students unpaired t-test and Chi-square test and Mann–Whitney test Z†value wherever appropriate. A p<0.05 was considered statistically significant.

Results: Based on comparable demographic profiles, time for the requirement of first post-operative rescue analgesia (262.43±57.13 vs. 256.30±44.4) min and total mean rescue analgesic requirement was 152.50±57.367 vs. 142.50±41.07 mg in Groups 1 and 2, respectively. Group 1 showed slightly prolonged duration of analgesia, but total analgesic requirement was more than Group 2. However, comparing the duration of analgesia and total analgesic requirement showed no statistically significant difference between the groups (p>0.05).

Conclusion: Both ropivacaine and bupivacaine injected intra-articularly have similar efficacy statistically in relieving post-operative pain in day-care arthroscopic knee surgery.

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Author Biographies

Sai Kaushik P H, Department of Anaesthesiology, Kasturba Medical College, Mangalore, Manipal University, Manipal, Karnataka, India.


KMC Mangalore

Manipal University, Manipal

Shaila S Kamath, Department of Anaesthesiology, Kasturba Medical College, Mangalore, Manipal University, Manipal, Karnataka, India.

Professor and Head

Department of Anaesthesiology

 

Surendra U Kaminuath, Department of Orthopaedics, Kasturba Medical College, Mangalore, Manipal University, Manipal, Karnataka, India.

Professor and Head

Department of Orthopaedics

References

Samoladas EP, Chalidis B, Fotiadis H, Terzidis I, Ntobas T, Koimtzis M. The intra-articular use of ropivacaine for the control of post knee arthroscopy pain. J Orthop Surg Res 2006;23:117.

Franceschi F, Rizzello G, Cataldo R, Denaro V. Comparison of morphine and ropivacaine following knee arthroscopy. Arthroscopy 2001;17:477-80.

Das A, Majumdar S, Kundu R, Mitra T, Mukherjee A, Hajra BK, et al.

Pain relief in day care arthroscopic knee surgery: A comparison between intra-articular ropivacaine and levobupivacaine: A prospective, double-blinded, randomized controlled study. Saudi J Anaesth 2014;8:368-73.

Convery PN, Milligan KR, Quinn P, Sjövall J, Gustafsson U. Efficacy and uptake of ropivacaine and bupivacaine after single intra-articular injection in the knee joint. Br J Anaesth 2001;87:570-6.

Gupta A, Axelsson K, Allvin R, Liszka-hackzell J, Rawal N, Althoff B, et al. Postoperative pain following knee arthroscopy: The effects of intra-articular ketorolac and/or morphine. Reg Anesth Pain Med 1999;24:225-30.

Chan ST. Intra-articular morphine and bupivacaine for pain after therapeutic arthroscopic knee surgery. Singapore Med J 1995;36:35-7.

Gürkan Y, Kiliçkan L, Buluc L, Müezzinoglu S, Toker K. Effects of diclofenac and intra-articular morphine/bupivacaine on postarthroscopic pain control. Minerva Anestesiol 1999;65:741-5.

Foster RH, Markham A. Levobupivacaine: A review of its pharmacology and use as a local anaesthetic. Drugs 2000;59:551-79.

Scott DB, Lee A, Fagan D, Bowler GM, Bloomfield P, Lundh R, et al. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg 1989;69:563-9.

Vainionpää VA, Haavisto ET, Huha TM, Korpi KJ, Nuutinen LS, Hollmén AI, et al. A clinical and pharmacokinetic comparison of ropivacaine and bupivacaine in axillary plexus block. Anesth Analg 1995;81:534-8.

Al-Metwalli RR, Mowafi HA, Ismail SA, Siddiqui AK, Al-Ghamdi AM, Shafi MA, et al. Effect of intra-articular dexmedetomidine on postoperative analgesia after arthroscopic knee surgery. Br J Anaesth 2008;101:395-9.

Chirwa SS, MacLeod BA, Day B. Intraarticular bupivacaine (Marcaine) after arthroscopic meniscectomy: A randomized double-blind controlled study. Arthroscopy 1989;5:33-5.

Dye SF, Vaupel GL, Dye CC. Conscious neurosensory mapping of the internal structures of the human knee without intraarticular anesthesia. Am J Sports Med 1998;26:773-7.

Rawal N. Analgesia for day-case surgery. Br J Anaesth 2001;87:73-87.

Marret E, Gentili M, Bonnet MP, Bonnet F. Intra-articular ropivacaine 0.75% and bupivacaine 0.50% for analgesia after arthroscopic knee surgery: A randomized prospective study. Arthroscopy 2005;21:313-6.

Mandal P, Saudagar AH. Intra-articular fentanyl for analgesia following arthroscopic knee surgery. Indian J Anaesth 2002;46:107-10.

Ersan Ö, Akkaya T, Arık E, Ateş Y. Intra-articular levobupivacaine, lornoxicam and morphine analgesia after knee arthroscopy: A randomized, controlled trial. Acta Orthop Traumatol Turc 2012;46:411-5.

Georgopoulos G, Carry P, Pan Z, Chang F, Heare T, Rhodes J, et al. The efficacy of intra-articular injections for pain control following the closed reduction and percutaneous pinning of pediatric supracondylar humeral fractures: A randomized controlled trial. J Bone Joint Surg Am 2012;94:1633-42.

Wasudev G, Smith BE, Limbird TJ. Blood levels of bupivacaine after arthroscopy of the knee joint. Arthroscopy 1990;6:40-2.

Kaeding CC, Hill JA, Katz J, Benson L. Bupivacaine use after knee arthroscopy: Pharmacokinetics and pain control study. Arthroscopy 1990;6:33-9.

Calmet J, Esteve C, Boada S, Giné J. Analgesic effect of intra-articular ketorolac in knee arthroscopy: Comparison of morphine and bupivacaine. Knee Surg Sports Traumatol Arthrosc 2004;12:552-5.

Dal D, Tetik O, Altunkaya H, Tetik O, Doral MN. The efficacy of intra-articular ketamine for postoperative analgesia in outpatient arthroscopic surgery. Arthroscopy 2004;20:300-5.

Sun QB, Liu SD, Meng QJ, Qu HZ, Zhang Z. Single administration of intra-articular bupivacaine in arthroscopic knee surgery: A systematic review and meta-analysis. BMC Musculoskelet Disord 2015;16:21.

Rautoma P, Santanen U, Avela R, Luurila H, Perhoniemi V, Erkola O, et al. Diclofenac premedication but not intra-articular ropivacaine alleviates pain following day-case knee arthroscopy. Can J Anaesth 2000;47:220-4.

Campo MM, Kerkhoffs GM, Sierevelt IN, Weeseman RR, Van der Vis HM, Albers GH, et al. A randomised controlled trial for the effectiveness of intra-articular ropivacaine and bupivacaine on pain after knee arthroscopy: The DUPRA (DUtch pain relief after arthroscopy)-trial. Knee Surg Sports Traumatol Arthrosc 2012;20:239-44.

Weiker GG, Kuivila TE, Pippinger CE. Serum lidocaine and bupivacaine levels in local technique knee arthroscopy. Am J Sports Med 1991;19:499-502.

Ng HP, Nordström U, Axelsson K, Perniola AD, Gustav E, Ryttberg L, et al. Efficacy of intra-articular bupivacaine, ropivacaine, or a combination of ropivacaine, morphine, and ketorolac on postoperative pain relief after ambulatory arthroscopic knee surgery: A randomized double-blind study. Reg Anesth Pain Med 2006;31:26-33.

Chu CR. In vivo effects of single intra-articular injection of 0.5% bupivacaine on articular cartilage. J Bone Jt Surg 2010;92:599.

Chu CR, Izzo NJ, Coyle CH, Papas NE, Logar A. The in vitro effects of bupivacaine on articular chondrocytes. J Bone Joint Surg Br 2008;90:814-20.

Chu CR, Izzo NJ, Papas NE, Fu FH. In vitro exposure to 0.5% bupivacaine is cytotoxic to bovine articular chondrocytes. Arthroscopy 2006;22:693-9.

Grishko V, Xu M, Wilson G, Pearsall AW. Apoptosis and mitochondrial dysfunction in human chondrocytes following exposure to lidocaine, bupivacaine, and ropivacaine. J Bone Jt Surg 2010;92:609-18.

Møiniche S, Mikkelsen S, Wetterslev J, Dahl JB. A systematic review of intra-articular local anesthesia for postoperative pain relief after arthroscopic knee surgery. Reg Anesth Pain Med 1999;24:430-7.

Venkatraman R, Sandhya R. Evaluation of efficacy of epidural butorphanol tartrate for postoperative analgesia. Int J Pharm Pharm Sci 2015;7:52-4.

Vidya VS, Felicita AS. Efficacy of pharmacological agents in the treatment of temporomandibularjoint disorder: A systematic review. Int J Pharm Pharm Sci 2015;7:54-8.

Published

01-02-2018

How to Cite

P H, S. K., S. S. Kamath, and S. U. Kaminuath. “A COMPARISON BETWEEN INTRA-ARTICULAR 0.2% ROPIVACAINE AND 0.25% BUPIVACAINE FOR POST-OPERATIVE ANALGESIA FOLLOWING DAY-CARE ARTHROSCOPIC KNEE SURGERIES”. Asian Journal of Pharmaceutical and Clinical Research, vol. 11, no. 2, Feb. 2018, pp. 422-6, doi:10.22159/ajpcr.2018.v11i2.23200.

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Original Article(s)