The postoperative analgesic effects of intra-articular levobupivacaine in elective day-case arthroscopy of the knee: a prospective, randomized, double-blind clinical study

Jacobson, Eva; Assareh, Hamid; Cannerfelt, Ronnie; Anderson, R. E.; Jakobsson, Jan

doi:10.1007/s00167-005-0655-4

Cited by 21 publications

(23 citation statements)

References 21 publications

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“…43 In arthroscopic knee surgery, 6 studies meeting our search criteria were identified. 44–49 Four of the 6 compared SSLPB or IA injection to placebo or no block and showed a positive analgesic effect. 44–47 SSLPB with sciatic block was superior to SSFNB with sciatic block in arthroscopic knee surgery.…”

Section: Resultsmentioning

confidence: 99%

Preventive Analgesia by Local Anesthetics

Barreveld

Witte

Chahal³

et al. 2013

Anesthesia &Amp; Analgesia

142

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The use of local anesthetics to reduce acute postoperative pain has a long history, but recent reports have not been systematically reviewed. In addition, the need to include only those clinical studies that meet minimum standards for randomization and blinding must be adhered to. In this review we have applied stringent clinical study design standards to identify publications on the use of perioperative local anesthetics. We first examined several types of peripheral nerve blocks, covering a variety of surgical procedures, and second, for effects of intentionally administered IV local anesthetic (lidocaine) for suppression of postoperative pain. Thirdly, we have examined publications in which vascular concentrations of local anesthetics were measured at different times after peripheral nerve block procedures, noting the incidence when those levels reached ones achieved during intentional IV administration. Importantly, the very large number of studies using neuraxial blockade techniques (epidural, spinal) has not been included in this review but will be dealt with separately in a later review. The overall results showed a strongly positive effect of local anesthetics, by either route, for suppressing postoperative pain scores and analgesic (opiate) consumption. In only a few situations were the effects equivocal. Enhanced effectiveness with the addition of adjuvants was not uniformly apparent. The differential benefits between drug delivery before, during, or immediately after a surgical procedure are not obvious, and a general conclusion is that the significant antihyperalgesic effects occur when the local anesthetic is present during the acute postoperative period, and its presence during surgery is not essential for this action.

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Section: Resultsmentioning

confidence: 99%

Preventive Analgesia by Local Anesthetics

Barreveld

Witte

Chahal³

et al. 2013

Anesthesia &Amp; Analgesia

142

View full text Add to dashboard Cite

show abstract

“…Jacobson et al [21] compared two groups that received intra-articular levobupivacaine at 0.25% and 0.5% concentrations with another group that received intra-articular 1% lidocaine with adrenaline (total volume 20 mL). They found that 0.5% levobupivacaine provided better analgesia in the first 24 post-operative hours than 0.25% levobupivacaine and the lidocaine-adrenaline combination.…”

Section: Discussionmentioning

confidence: 99%

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

Ozdemir

Kaya

Gurbet

et al. 2013

EAJM

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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.

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“…Although there may remain some questions as to whether or not local anesthetics are safe for intra-articular administration, studies conducted have not addressed the matter of any adverse effects from the intra-articular administration of levobupivacaine [10,13]. Levobupivacaine is the levo isomer of bupivacaine with a similar effect profile but a documented reduced cardiotoxicity compared to traditional racimate bupivacaine and therefore has a wider safety margin [14].…”

Section: Discussionmentioning

confidence: 99%

“…It has also been administered intraarticularly in some clinical studies. Jacobson et al [13] compared levobupivacaine 2.5 mg/ml, levobupivacaine 5 mg/ml, and lidocaine 10 mg/ml and adrenaline solution given intra-articularly to patients undergoing day-case elective arthroscopy of the knee and found that levobupivacaine 5 mg/ml was an effective local anesthetic in day-case arthroscopy providing superior postoperative analgesia when compared to lidocaine and adrenaline solution or a lower concentration of levobupivacaine. In another study Karaman et al [10] concluded that the results of their study showed that intra-articular 20 ml 0.5% levobupivacaine provides effective analgesia comparable to that provided by 20 ml 0.5% bupivacaine.…”

Section: Discussionmentioning

confidence: 99%