Comparison of Intraarticular Bupivacaine and Levobupivacaine with Morphine and Epinephrine for Knee Arthroscopy

Abstract

Objective: To compare the efficacy of intraarticularly injected bupivacaine with levobupivacaine when administered in combination with morphine and adrenaline for post-operative analgesia and functional recovery after knee surgery. Materials and Methods:Sixty American Society of Anesthesiologists physical status I-II patients were randomized into three groups: Group B was administered 30 mL isobaric 0.5% bupivacaine, 2 mg morphine and 100 μg adrenaline, Group L was administered 30 mL 0.5% levobupivacaine, 2 mg morphine and 100 μg adrenaline, and Group C was administered 30 mL 0.9% NaCl solution into the knee joint by the surgeon at the end of surgery. The morphine usage and visual analog pain scores were recorded regularly afterwards. We also recorded the time that elapsed before each patients' first mobilization, positive response to straight leg raising, tolerance to 30-50° knee flexion, recovery of quadriceps reflexes and discharge from the hospital. We also recorded patient and surgeon satisfaction. Results:The pain scale values were lower in Groups B and L than in Group C at 2, 4, 6, 8, 12 and 24 hours post-operatively (all p<0.001). In Groups B and L, the time for first analgesic request was longer (p<0.01), the morphine consumption was lower (p<0.001), and the duration of morphine usage was shorter (p<0.001). The times to positive response to straight leg raising, tolerance to 30-50° knee flexion and the first mobilization were shorter in Groups B and L (p<0.001 for all). Conclusion:After arthroscopic knee surgery, intraarticular levobupivacaine combined with morphine and adrenaline decreases analgesic requirements, shortens the postoperative duration of analgesic use and hastens mobilization as effectively as bupivacaine.

Efficacy of Intra-articular Versus Extra-articular Bupivacaine Injection in Arthroscopic Partial Meniscectomy: A Prospective, Randomized, Double-Blind Clinical Trial

“…For example, in a study that included 60 patients who underwent an arthroscopic knee surgery, intra-articular levobupivacaine combined with morphine and adrenaline or only bupivacaine decreased the postoperative duration of analgesic use and accelerated knee mobility. 26 On the other hand, some studies did not reveal any significant benefit to the different intra-articular anesthetic treatments. Solheim et al 30 compared the analgesic effect of intra-articular administration of saline or 5 mg morphine and found that there were no differences in pain intensity or pain relief at any time during the 48-hour observation period between morphine or saline.…”

“…The administration of various local anesthetic drugs into the joint space, either by a single injection or by a continuous infusion, to ameliorate postoperative pain following knee arthroscopy had been investigated, with some studies showing a beneficial effect while other studies did not. 26 , 30 , 34 …”

“…15,18 The administration of various local anesthetic drugs into the joint space, either by a single injection or by a continuous infusion, to ameliorate postoperative pain following knee arthroscopy had been investigated, with some studies showing a beneficial effect while other studies did not. 26,30,34 Bupivacaine is commonly used for intra-articular analgesia because of its extended duration of action. The peak plasma concentrations of the drug upon intra-articular injection were found to be low, rendering systemic toxicity extremely unlikely.…”

Comparison of Intra-Articular Bupivacaine and Neostigmine with Bupivacaine and Fentanyl for Post-Operative Analgesia in Arthroscopic Knee Surgeries

“…This hemodynamic profile is similar to various studies reviewed by us that have not reported any serious hemodynamic event in Fentanyl or Neostigmine group. [9][10][11][12][15][16][17][18][19][20][21][22] Kayacan et al [8] compared intra-articular Neostigmine to intra-articular Tramadol, Tenoxicam and Bupivacaine and found that compared to Bupivacaine group, Neostigmine had a relatively much stable hemodynamic profile, thus indicating that Neostigmine exercises a better hemodynamic control as compared to Bupivacaine. In the present study, Bupivacaine was used in all the three groups, however, hemodynamic profile of Neostigmine was no different from Bupivacaine alone group thus signifying that Neostigmine did not induce any additional hemodynamic change and thus was safe to be used even when used in combination with Bupivacaine.…”

Biased, Bitopic, Opioid–Adrenergic Tethered Compounds May Improve Specificity, Lower Dosage and Enhance Agonist or Antagonist Function with Reduced Risk of Tolerance and Addiction

“…Various combinations of opioids and adrenergics demonstrate synergistic antinociceptive activity [14][15][16][17] that involves both α-adrenergic and β-adrenergic [18,19] components. For example, the addition of an adrenergic drug such as epinephrine or clonidine significantly reduces the amount of morphine required and its frequency of administration in the peri-and post-operative periods for a wide range of different types of surgeries [20][21][22][23][24][25][26][27][28][29]. The combination significantly decreases the need for intra-operative opiates [27,30], increases the duration of operative analgesia into the post-operative period [20][21][22][23][24]27,30,31].…”