Analgesic effect of intra-articular bupivacaine or diamorphine after arthroscopic surgery of the knee joint in day-case patients

Single administration of intra-articular bupivacaine in arthroscopic knee surgery: a systematic review and meta-analysis

Background

Single administration of intra-articular (IA) bupivacaine for pain relief after arthroscopic knee surgery is effective, but its active duration and dose–response relationship is unclear. We conducted this meta-analysis to summarize all published randomized controlled trials (RCTs), thus providing the most recent information on the safety and efficacy of single-administration IA bupivacaine for pain relief after arthroscopic knee surgery, and to determine whether a dose–response relationship exists.

Methods

A systematic electronic literature search (through April 2014) was conducted to identify those RCTs that addressed the safety and efficacy of a single administration of IA bupivacaine for pain management after arthroscopic knee surgery. Subgroup analysis was conducted to determine changes in visual analog scale (VAS) scores at seven postoperative time points. Meta-regression and subgroup analyses were carried out to assess the effects of various treatment factors on efficacy and to evaluate the dose–response relationship of bupivacaine. Weighted mean differences or relative risks were calculated and pooled using a random-effects model.

Results

Twenty-eight trials involving 1,560 patients who underwent arthroscopic knee surgery met the inclusion criteria. The trials were subject to medium risk of bias. VAS scores at 2, 4, 6, 12, and 24 h postoperatively were significantly lower, the number of patients requiring supplementary analgesia was smaller, and the time to first request for analgesia was longer in the IA bupivacaine group than in the placebo group. The analgesic effect of single-administration IA bupivacaine may be associated with the effect of concomitant administration of epinephrine and concentration of bupivacaine, and no dose–response relationship was identified. No significant difference in side effects was detected between groups.

Conclusions

Current evidence shows that the use of single-administration IA bupivacaine is effective for postoperative pain management in patients undergoing arthroscopic knee surgery, with satisfactory short-term safety. Low-dose administration of IA bupivacaine 0.5% combined with epinephrine adjuvant in clinical practice should be performed. Additional high-quality RCTs with longer follow-up periods are required to examine the safety of single-administration IA bupivacaine.

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-015-0477-6) contains supplementary material, which is available to authorized users.

Pre- versus postoperative intraarticular application of local anesthetics and opioids versus femoral nerve block in anterior cruciate ligament repair

BACKGROUND

Often anterior cruciate ligament (ACL) reconstruction is performed as outpatient surgery. This requires a patient friendly postoperative pain management. Three common procedures were compared in this trial.

METHODS

In a prospective, randomized study the effect of postoperative pain management using preoperative intraarticular anesthesia (0.1 mg Fentanyl + 8 ml Bupivacain 0.5%) was compared with postoperative intraarticular anesthesia (0.1 mg Fentanyl + 8 ml Bupivacain 0.5%) and the femoralis 3-in-1 nerve block (20 ml Prilocain 1% + 20 ml Bupivacain 0.5%) in 157 patients who underwent arthroscopic ACL-plasty.

RESULTS

Preoperative intraarticular anesthesia and the femoralis 3-in-1 nerve block showed the same postoperative analgesia and satisfactory pain scores in most cases. Postoperative intraarticular anesthesia was less effective.

CONCLUSION

Our data show that in anterior cruciate ligament reconstruction preoperative intraarticular analgesia with Bupivacain/Fentanyl is satisfactory and equal to the femoralis 3-in-1 nerve block with Bupivacain.

[Outpatient arthroscopic surgery]

Arthroscopic surgery is being used more and more frequently worldwide for a growing number of indications and for almost all joints. In Germany, there is, however, no consensus on correct methods of arthroscopic surgery on an outpatient basis. Structural, personnel, and anesthesiologic factors and appropriate follow-up care play important roles in this type of operation. This study examines some basic requirements and presents an overview of the individual indications for such operations performed in an outpatient setting.