Arthroscopy of the Knee; Impact of Intraarticular Pain Management

Abstract

ABSTRACT... Introduction: Arthroscopy has a significant efficacy amongst patients, but is dependent on the anasthesia used. This is particularly important, as research on knee arthroscopy has established importance on anasthesia, particularly the type and number used. Study Research Objective: This study conducted over a period of 2 years, included all patients undergoing knee arthroscopy, irrespective of age, gender and underlying conditions (whether traumatic, degenerative, infective or inflammatory). In this study the Impact of postoperative pain management on patient recovery was evaluated. There is evidence that the knee joint has morphine receptors, thus nalbuphin was used. Study Design: Randomized Case Control Study. Setting: Department of KRL Hospital. Period: Jan 2014 to Dec 2015. Methodology: Randomization was done through the random number generator function provided by Open EPI Ver. 3.01. The random numbers generated were compared with serial numbers assigned to patients through consent forms and then assigned to the three groups accordingly (Control, Lignocaine, Lignocaine + Nalbucin). Out of 117 patients 6 patients were given general anesthesia and 111 were given spinal anesthesia. Arthroscopy was done under tourniquet control. To measure pain thresholds, a visual analogue scale from 1 to 9 was used and then made into three groups: mild (1-3), moderate (4-6) and severe (7-9). Patient Mobilization was measured 4, 6, 8, 10, 12, 14, and 16 hours post operation. Analysis was done using OpenEPI Ver. 3.01 and Microsoft Excel 2013 separately for both Lignocaine and Lignocaine + Nalbuphin. A systematic literature review was done to compare the results found in this study with those found in this study. For this purpose, the following string was used in Google Scholar and Pubmed: "Arthroscopy" AND "TB" AND "Synovial Biopsy" and "Postoperative Pain Management" AND "Arthroscopy" AND "Knee Joint". Results: Interventions of Lignocaine and Lignocaine + Nalbucin were more effective than control. Lignocaine + Nalbucin combined showed higher chances of mobility when compared to Lignocaine and control. Systematic Literature Review also provided similar results. Conclusion: If this procedure is performed with the correct expertise and the patient given intra articular lignocaine and Nalbuphin, the patients show early and good recovery and therefore they can be discharged the same day thus reducing the cost on the patient as well as the hospital.