Arthroscopy and Sports Medicine

Archives of Orthopaedic and Trauma Surgery

, Volume 129, Issue 3, pp 343-348

Pre-emptive intra-articular administration of local anaesthetics/opiates versus postoperative local anaesthetics/opiates or local anaesthetics in arthroscopic surgery of the knee joint: a prospective randomized trial

  • R. HubeAffiliated withOCM-KlinikKlinik und Poliklinik für Orthopädie, Martin-Luther-Universität Halle-Wittenberg Email author 
  • , M. TrögerAffiliated withKlinik für Unfall- und Wiederherstellungschirurgie Henriettenstiftung
  • , F. RickerlAffiliated withOCM-Klinik
  • , E. O. MuenchAffiliated withOCM-Klinik
  • , R. von Eisenhart-RotheAffiliated withAsclepios Orthopädische Klinik
  • , W. HeinAffiliated withKlinik und Poliklinik für Orthopädie, Martin-Luther-Universität Halle-Wittenberg
  • , H. O. MayrAffiliated withOCM-KlinikKlinik und Poliklinik für Orthopädie, Martin-Luther-Universität Halle-Wittenberg

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Abstract

Aim

Arthroscopic surgery on the knee joint is increasingly being performed as day-case surgery. This necessitates adequate postoperative pain therapy. We performed a study to compare three different intra-articular regimens of pain treatment. The hypothesis was that preoperative intra-articular pain management is superior to postoperative procedures.

Method

In this study we compared the preoperative administration of 0.1 mg fentanyl + 5 ml bupivacaine 0.5% with the postoperative administration of either 0.1 mg fentanyl + 5 ml bupivacaine 0.5% or 5 ml bupivacaine 0.5% alone in a total of 564 patients. Participants were randomly assigned to three groups. Each group was subdivided into patients with and without synovitis.

Results

The preoperative administration of fentanyl and bupivacaine significantly decreased the perceived pain. The efficiency increased with major arthroscopic procedures. Postoperative administration of bupivacaine alone had the least effect. There was variation within each group depending on whether synovitis was present or not.

Conclusion

This study demonstrated the superiority of the preoperative intra-articular administration of a combination of fentanyl and local anaesthetic over postoperative fentanyl and local anaesthetic or postoperative local anaesthetic alone.

Keywords

Knee arthroscopy Pre-emptive analgesia Pre-emptive fentanyl Co-analgesic effect Intra-articular analgesia