Comparison of the effects of intra-articular sole ropivacaine and combined ketorolac and ropivacaine for pain control after knee arthroscopy surgery

Abstract

Introduction: Effective pain relief is important after arthroscopic knee surgery to permit initiation of daily activities of life. This study is performed in order to investigate the effect of multi-model therapy for pain control after surgery. This clinical, randomized and double-blind trial is conducted on patients who get knee arthroscopy surgery. Methods: Of these patients, 40 were divided into two groups by Block Randomization method: 1 -sole ropivacaine group (150 mg); 2 -combined ketorolac (30 mg); and ropivacain (150 mg) group. These drugs were injected intra-articularly at the end of knee arthroscopic surgery. The first consequence including measurement of pain severity after entrance to recovery room and 2, 4, 8, 12, 18 and 24 hours after surgery were evaluated according to the visual analogue pain score. The second consequence, including nausea, vomiting and sedation, was assessed by expert nurses in the recovery room and surgery part according to nausea and vomiting scale and Ramsay sedation scale, respectively. Results: All groups had excellent analgesia at 0 and 4 hours, postoperatively. Group-combined ketorolac and ropivacaine had significantly lower visual analogue pain score as well as higher sedative scale at 8, 12, 18 and 24 hours after surgery at rest and during movement compared with the other group (p < 0.05). Moreover, there was no statistical difference between groups in regard of nausea and vomiting. Conclusion: Addition of ketolorac to ropivacaine intra-articularly in arthroscopic knee surgery enhances analgesic efficacy of local anaesthetics and cause more sedation after surgery.

Influence of Ketorolac Supplementation on Pain Control for Knee Arthroscopy: A Meta‐Analysis of Randomized Controlled Trials

“…Three articles are excluded for not being RCT. Finally, ten RCTs that meet our inclusion criteria are included in the meta‐analysis.…”

“…Our meta‐analysis suggests that compared to control intervention for knee arthroscopy, ketorolac supplementation can favorably reduce pain scores at 1 h and 2 h, prolong the time for first analgesic requirement, and decrease the number of analgesic requirements, with no significant influence on analgesic consumption. Regarding the sensitivity analysis, there is significant heterogeneity for the pain scores at 2 h. One included RCT reports postoperative injection of 60 mg intra‐articular ketorolac vs placebo for pain relief, whereas the other included RCT involves intra‐articular 0.25% bupivacaine (28 mL) with ketorolac (60 mg) vs intra‐articular 0.25% bupivacaine (30 mL). These indicate that the significant heterogeneity may be caused by the different combination of ketorolac, and the combination of ketorolac and bupivacaine may have synergistic effects for pain management.…”

“…Intra‐articular analgesia offer important potential in reducing postoperative disability, preventing the onset of pain, and avoiding the need for additional drugs. It may reach good analgesia in the immediate postoperative period by the administration of analgesic drugs.…”

“…NSAIDs such as ketorolac administered intra‐articularly provide good postoperative pain relief after the surgery. Ketorolac has a high affinity with protein, and produces the analgesic effect through harnessing the production of prostaglandins.…”

“…However, the efficacy of ketorolac supplementation on pain control after knee arthroscopy has not been well established. Recently, several studies on the topic have been published, and the results have been conflicting. With accumulating evidence, we therefore perform a systematic review and meta‐analysis of RCTs to investigate the efficacy of ketorolac supplementation vs placebo on pain management after knee arthroscopy.…”