Intra Articular Administration; To Determine the Analgesic Efficacy of Bupivacaine and Compare It With Levobupivacaine, During Surgical Procedures of the Knee Joint

Abstract

ABSTRACT… Objectives:The aim of our study is to provide a comparison between levobupivacaine and bupivacaine administered intra articulary in the knee joint during arthroplasty procedures, and compare the postoperative analgesic effects. Method: Study Design: Randomized control trial. Period: One year duration from March 2015 to March 2016. Setting: Tertiary care centre in Karachi, Pakistan. The study population consisted of n= 50 patients belonging to ASA class II and III, who were scheduled to undergo TKA (total knee arthroplasty). The patient population was divided into two groups, group A consisted of all the patients who received bupivacaine, and group B consisted of all the patients who received levobupivacaine. All the patients were between the ages of 18 and 70 years, and had normal joint mobility. After explaining the procedure and taking due informed consent, the patients were informed about the use of the visual analog scale for pain and the patients controlled epidural anesthesia (PCEA). Readings of echocardiograph, blood pressure and pulse oximetry, sensory and motor characteristics of the established block, side effects, number of boluses and doses of PCEA, total amount of pain relief medications utilized over the period, VAS scores and time of mobilization and discharge from the hospital were also noted in a pre-designed. Statistical analysis was done using SPSS version 23. Results: The study population consisted of n= 50 patients. The VAS scores at were found to be lower in the bupivacaine group at 4,8,12 and 24 hours and VAS scores at 48 hour were lower in levobupivacaine group having a p value of less than 0.05, but the VAS scores were similar at the 0,2 and 72 hours in both the groups. The post-operative analgesic requirement was similar for both groups. The sensation of pain at the time of post-operative physiotherapy measure with the VAS score, was also similar in the two groups having a p value of less than 0.05. Similar results were found between the time of discharge and time of mobility, having a p value of less than 0.05. Conclusion: The use of multimodal analgesia with the administration of intra articular local anesthetics combined with PCEA is a very effective method to provide post-operative pain relief in patients undergoing total knee arthroplasty. Key words:Intra articular administration, knee arthroplasty, levobupivacaine, bupivacaine, post-operative analgesia, patient controlled epidural analgesia.

Magnesium Sulfate Combined with a Levobupivacaine Periarticular Cocktail for Analgesia in the Early Postoperative Period after Total Knee Arthroplasty

“…Levobupivacaine is an enantiomer of bupivacaine; due to the removal of the dextroisomer, the cardiac toxicity of levobupivacaine is significantly reduced, 7 and its anesthesia effect is not weaker than that of bupivacaine, but the adverse reactions are significantly less than those of bupivacaine. As a kind of long-acting amide local anesthetic, levobupivacaine has the advantages of a quick onset, long duration, and definite analgesic effect.…”