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Single-dose intra-articular ropivacaine after arthroscopic knee surgery decreases post-operative pain without increasing side effects: a systematic review and meta-analysis

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to appraise the efficacy and safety of single-dose intra-articular ropivacaine administered for pain relief after arthroscopic knee surgery.

Methods

PubMed, Embase, and Cochrane Library databases were searched in October 2014 to identify randomized controlled trials of single-dose intra-articular ropivacaine for post-operative pain relief. Post-operative pain intensity, the amount of rescue analgesia required, and side effects including local anaesthetic toxicity were assessed. The relative risk (RR), the weighted mean difference (WMD), and their corresponding 95 % confidence intervals (CIs) were calculated.

Results

Eight randomized controlled trials were included in the analysis. Statistically significant differences in the visual analogue scale for pain intensity value were observed during the immediate post-operative period (WMD −10.35, 95 % CI −17.12 to −3.59, p = 0.003) and the early post-operative period (WMD −11.90, 95 % CI −18.12 to −5.69, p = 0.0002), but not during the late post-operative period (WMD −2.89, 95 % CI −7.46 to 1.68, n.s.). There was no significant difference in the amount of rescue analgesia required (RR 0.76, 95 % CI 0.52–1.11, n.s.). Only two trials reported the incidence of drug-related side effects (including nausea and vomiting): the incidence in the ropivacaine groups was no higher than that in the control groups. Only one trial assessed local anaesthetic toxicity as an outcome, but it was not detected.

Conclusions

Single-dose intra-articular ropivacaine administered at the end of arthroscopic knee surgery provides effective pain relief in the immediate and early post-operative periods without increasing short-term side effects.

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References

  1. Armellin G, Nardacchione R, Ori C (2008) Intra-articular sufentanil in multimodal analgesic management after outpatient arthroscopic anterior cruciate ligament reconstruction: a prospective, randomized, double-blinded study. Arthroscopy 24:909–913

    Article  PubMed  Google Scholar 

  2. Baker JF, Byrne DP, Walsh PM, Mulhall KJ (2011) Human chondrocyte viability after treatment with local anesthetic and/or magnesium: results from an in vitro study. Arthroscopy 27:213–217

    Article  PubMed  Google Scholar 

  3. Baker JF, Walsh PM, Byrne DP, Mulhall KJ (2011) In vitro assessment of human chondrocyte viability after treatment with local anaesthetic, magnesium sulphate or normal saline. Knee Surg Sports Traumatol Arthrosc 19:1043–1046

    Article  CAS  PubMed  Google Scholar 

  4. Begg B, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101

    Article  CAS  PubMed  Google Scholar 

  5. Breu A, Rosenmeier K, Kujat R, Angele P, Zink W (2013) The cytotoxicity of bupivacaine, ropivacaine, and mepivacaine on human chondrocytes and cartilage. Anesth Analg 117:514–522

    Article  CAS  PubMed  Google Scholar 

  6. Camorcia M, Capogna G, Lyons G, Columb MO (2004) The relative motor blocking potencies of intrathecal ropivacaine: effects of concentration. Anesth Analg 98:1779–1782

    Article  PubMed  Google Scholar 

  7. Campo MM, Kerkhoffs GM, Sierevelt IN, Weeseman RR, Van der Vis HM, Albers GH (2012) A randomised controlled trial for the effectiveness of intra-articular ropivacaine and bupivacaine on pain after knee arthroscopy: the DUPRA (DUtch Pain Relief after Arthroscopy)-trial. Knee Surg Sports Traumatol Arthrosc 20:239–244

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Chu CR, Izzo NJ, Coyle CH, Papas NE, Logar A (2008) The in vitro effects of bupivacaine on articular chondrocytes. J Bone Joint Surg Br 90:814–820

    Article  CAS  PubMed  Google Scholar 

  9. Dauri M, Fabbi E, Mariani P, Faria S, Carpenedo R, Sidiropoulou T, Coniqlione F, Silvi MB, Sabato AF (2009) Continuous femoral nerve block provides superior analgesia compared with continuous intra-articular and wound infusion after anterior cruciate ligament reconstruction. Reg Anesth Pain Med 34:95–99

    Article  PubMed  Google Scholar 

  10. Dragoo JL, Braum HJ, Kim HJ, Phan HD, Golish SR (2012) The in vitro chondrotoxicity of single-dose local anesthetics. Am J Sports Med 40:794–799

    Article  PubMed  Google Scholar 

  11. Elia N, Tramer MR (2005) Ketamine and postoperative pain—a quantitative systematic review of randomised trials. Pain 113:61–70

    Article  CAS  PubMed  Google Scholar 

  12. Emanuelsson BM, Persson J, Alm C, Heller A, Gustafsson LL (1997) Systematic absorption and block after epidural injection of ropivacaine in healthy volunteers. Anesthesiology 87:1309–1317

    Article  CAS  PubMed  Google Scholar 

  13. Franceschi F, Rizzello G, Cataldo R, Denaro V (2001) Comparison of morphine and ropivacaine following knee arthroscopy. Arthroscopy 17:477–480

    Article  CAS  PubMed  Google Scholar 

  14. Grishko V, Xu M, Wilson G, Pearsall AW IV (2010) Apoptosis and mitochondrial dysfunction in human chondrocytes following exposure to lidocaine, bupivacaine, and ropivacaine. J Bone Joint Surg Am 92:609–618

    Article  PubMed  Google Scholar 

  15. Ickert I, Herten M, Vogl M, Ziskoven C, Zilkens C, Krauspe R, Kircher J (2014) Opiods as an alternative to amide-type local anaesthetics for intra-articular application. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-2989-2

    PubMed  Google Scholar 

  16. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

    Article  CAS  PubMed  Google Scholar 

  17. Johansson B, Hallerbach B, Stubberod A, Janbu T, Edwin B, Glise H, Solhaug JH (1997) Preoperative local infiltration with ropivacaine for postoperative pain relief after inguinal hernia repair. A randomized controlled trial. Eur J Surg 163:1–8

    Google Scholar 

  18. Kalso E, Smith L, McQuay HJ, Andrew Moore R (2002) No pain, no gain: clinical excellence and scientific rigour—lessons learned from IA morphine. Pain 98:269–275

    Article  CAS  PubMed  Google Scholar 

  19. Kim S, Bosque J, Meehan JP, Jamali A, Marder R (2011) Increase in outpatient knee arthroscopy in the United States: a comparison of National Survey of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am 93:994–1000

    Article  PubMed  Google Scholar 

  20. Koh IJ, Chang CB, Seo ES, Kim SJ, Seong SC, Kim TK (2012) Pain management by periarticular multimodal drug injection after anterior cruciate ligament reconstruction: a randomized, controlled study. Arthroscopy 28:649–657

    Article  PubMed  Google Scholar 

  21. Kristensen PK, Pfeiffer-Jensen M, Storm JO, Thillemann TM (2014) Local infiltration analgesia is comparable to femoral nerve block after anterior cruciate ligament reconstruction with hamstring tendon graft: a randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 22:317–323

    Article  PubMed  Google Scholar 

  22. Lee BB, Ngan Kee WD, Wong EL, Liu JY (2001) Dose-response study of epidural ropivacaine for labor analgesia. Anesthesiology 94:767–772

    Article  CAS  PubMed  Google Scholar 

  23. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62:e1–e34

    Article  PubMed  Google Scholar 

  24. Lo IK, Sciore P, Chung M, Liang S, Boorman RB, Thornton GM, Rattner JB, Muldrew K (2009) Local anesthetics induce chondrocyte death in bovine articular cartilage disks in a dose- and duration-dependent manner. Arthroscopy 25:707–715

    Article  PubMed  Google Scholar 

  25. Lykoudi I, Kottis G, Nikolaou VS, Setaki P, Fassoulaki A, Efstathopoulos N (2011) Intra-articular morphine enhances analgesic efficacy of ropivacaine for knee arthroscopy in ambulatory patients. Orthopaedics 34:91

    Google Scholar 

  26. Marret E, Gentili M, Bonnet MP, Bonnet F (2005) Intra-articular ropivacaine 0.75 % and bupivacaine 0.50 % for analgesia after arthroscopic knee surgery: a randomized prospective study. Arthroscopy 21:313–316

    Article  PubMed  Google Scholar 

  27. McClellan KJ, Faulds D (2000) Ropivacaine: an update of its use in regional anaesthesia. Drugs 60:1065–1093

    Article  CAS  PubMed  Google Scholar 

  28. McClure JH (1996) Ropivacaine. Br J Anaesth 76:300–307

    Article  CAS  PubMed  Google Scholar 

  29. Moiniche S, Mikkelsen S, Wetterslev J, Dahl JB (1999) A systematic review of intra-articular local anesthesia for postoperative pain relief after arthroscopic knee surgery. Reg Anesth Pain Med 24:430–437

    Article  CAS  PubMed  Google Scholar 

  30. Onur T, Dang A (2014) Reduction of environmental temperature mitigates local anesthetic cytotoxicity in bovine articular chondrocytes. J Sports Sci Med 13:516–521

    PubMed  PubMed Central  Google Scholar 

  31. Park J, Sutradhar BC, Hong G, Choi SH, Kim G (2011) Comparison of the cytotoxic effects of bupivacaine, lidocaine, and mepivacaine in equine articular chondrocytes. Vet Anaesth Analg 38:127–133

    Article  CAS  PubMed  Google Scholar 

  32. Petterson N, Berggren P, Larsson M, Westman B, Hahn RG (1999) Pain relief by wound infiltration with bupivacaine or high-dose ropivacaine after inguinal hernia repair. Reg Anesth Pain Med 24:569–575

    Google Scholar 

  33. Piper SL, Kramer JD, Kim HT, Feelev BT (2011) Effects of local anesthetics on articular cartilage. Am J Sports Med 39:2245–2253

    Article  PubMed  Google Scholar 

  34. Rahnama R, Wang M, Dang AC, Kim HT, Kuo AC (2013) Cytotoxicity of local anesthetics on human mesenchymal stem cells. J Bone Joint Surg Am 95:132–137

    Article  PubMed  Google Scholar 

  35. Rao AJ, Johnston TR, Harris AH, Smith RL, Costouros JG (2014) Inhibition of chondrocyte and synovial cell death after exposure to commonly used anesthetics: chondrocyte apoptosis after anesthetics. Am J Sports Med 42:50–58

    Article  PubMed  Google Scholar 

  36. Rautoma P, Santanen U, Avela R, Luurila H, Perhoniemi V, Erkola O (2000) Diclofenac premedication but not intra-articular ropivacaine alleviates pain following day-case knee arthroscopy. Can J Anaesth 47:220–224

    Article  CAS  PubMed  Google Scholar 

  37. Simpson D, Curran MP, Oldfield V, Keathing GM (2005) Ropivacaine: a review of its use in regional anaesthesia and acute pain management. Drugs 65:2675–2717

    Article  CAS  PubMed  Google Scholar 

  38. Solheim N, Rosseland LA, Stubhaug A (2006) Intra-articular morphine 5 mg after knee arthroscopy does not produce significant pain relief when administered to patients with moderate to severe pain via an intra-articular catheter. Reg Anesth Pain Med 31:506–513

    Article  CAS  PubMed  Google Scholar 

  39. Stein C, Comisel K, Haimerl E, Yassouridis A, Lehrberger K, Herz A, Peter K (1991) Analgesic effect of intraarticular morphine after arthroscopic knee surgery. N Engl J Med 325:1123–1126

    Article  CAS  PubMed  Google Scholar 

  40. Sun R, Zhao W, Hao Q, Tian H, Tian J, Li L, Jia W, Yang K (2014) Intra-articular clonidine for post-operative analgesia following arthroscopic knee surgery: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 22:2076–2084

    Article  PubMed  Google Scholar 

  41. Wang J, Xu L, Zhang L, Luo LL (2006) Effect of ropivacaine with lidocaine on postoperative analgesia for knee arthroscopy: a randomized, double-blind, placebo-controlled trial. Chin J Evid Based Med 6:557–562

    Google Scholar 

  42. Wang X, Jia D, Chen X, Xu Y (2013) Comparison of intra-articular low-dose sufentanil, ropivacaine, and combined sufentanil and ropivacaine and post-operative analgesia of isolated anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 21:1140–1145

    Article  PubMed  Google Scholar 

  43. Wei J, Yang HB, Qin JB, Kong FJ, Yang TB (2014) Single-dose intra-articular bupivacaine after knee arthroscopic surgery: a meta-analysis of randomized placebo-controlled studies. Knee Surg Sports Traumatol Arthrosc 22:1517–1528

    Article  PubMed  Google Scholar 

  44. Zaric D (1996) The effect of continuous lumbar epidural infusion of ropivacaine (0.1 %, 0.2 % and 0.3 %) and 0.25 % bupivacaine on sensory and motor block in volunteers. Reg Anesth 21:14–25

    CAS  PubMed  Google Scholar 

  45. Zeng C, Gao SG, Cheng L, Luo W, Li YS, Tu M, Tian J, Xu M, Zhang FJ, Jiang W, Wei LC, Lei GH (2013) Single-dose intra-articular morphine after arthroscopic knee surgery: a meta-analysis of randomized placebo-controlled studies. Arthroscopy 29:1450–1458

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by Hunan Provincial Innovation Foundation for Postgraduate (CX2014A005), the Fundamental Research Funds for the Central Universities of Central South University, the National Natural Science Foundation of China (Nos. 81201420, 81272034, 81472130), the Provincial Science Foundation of Hunan (No. 14JJ3032), the Scientific Research Project of the Development and Reform Commission of Hunan Province ([2013]1199), the Scientific Research Project of Science and Technology Office of Hunan Province (2013SK2018), and the Doctoral Scientific Fund Project of the Ministry of Education of China (20120162110036).

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Social Medicine, School of Public Health, Central South University, Changsha, 410008, Hunan Province, China

    Yang Zhou & Tu-bao Yang

  2. Department of Orthopaedics, Xiangya Hospital, Central South University, #87 Xiangya Road, Changsha, 410008, Hunan Province, China

    Yang Zhou, Chao Zeng, Hui li, Tuo Yang & Guang-hua Lei

  3. Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, 410008, Hunan Province, China

    Tu-bao Yang & Jie Wei

Authors
  1. Yang Zhou
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Corresponding author

Correspondence to Guang-hua Lei.

Appendix: Search strategies

Appendix: Search strategies

PubMed

  1. 1.

    Arthroscopy [tiab] or arthroscopic [tiab] or arthroscope [tiab] or arthrosp* [tiab]

  2. 2.

    Arthroscopy [Mesh]

  3. 3.

    “Anterior cruciate ligament”[tiab]

  4. 4.

    “acl”[tiab]

  5. 5.

    OR/1-4

  6. 6.

    ropivacaine [Supplementary Concept]

  7. 7.

    ropivacain* [tiab]

  8. 8.

    OR/6-7

  9. 9.

    randomized[tiab]

  10. 10.

    placebo[tiab]

  11. 11.

    controlled[tiab]

  12. 12.

    random*[tiab]

  13. 13.

    trial*[tiab]

  14. 14.

    groups[tiab]

  15. 15.

    ((singl*[tiab] or doubl*[tiab] or tripl*[tiab]) and (mask*[tiab] or blind*[tiab]))

  16. 16.

    OR/10-15

  17. 17.

    5 AND 8 AND 16

Embase

  1. 1.

    (Arthroscopy or arthroscopic or arthroscope or arthrosp*): ti, ab

  2. 2.

    ‘Anterior cruciate ligament’/exp

  3. 3.

    (Anterior cruciate ligament): ti, ab

  4. 4.

    OR/1-3

  5. 5.

    ‘ropivacaine’/exp

  6. 6.

    ropivacain*: ti, ab

  7. 7.

    OR/5-6

  8. 8.

    (random* or control* or trial* or placebo): ti, ab

  9. 9.

    Groups: ti, ab

  10. 10.

    ((singl* or doubl*or tripl*) and (mask* or blind*)): ti, ab

  11. 11.

    OR/8-10

  12. 12.

    4 AND 7 AND 11

Cochrane Library

  1. 1.

    MeSH descriptor Arthroscopy explode all trees

  2. 2.

    (Arthroscopy or arthroscopic or arthroscope or arthrosp*): ti, ab, kw

  3. 3.

    MeSH descriptor ‘Anterior cruciate ligament’ explode all trees

  4. 4.

    (Anterior cruciate ligament): ti, ab, kw

  5. 5.

    OR/1-4

  6. 6.

    MeSH descriptor ropivacaine explode all trees

  7. 7.

    ropivacain*: ti, ab

  8. 8.

    OR/6-7

  9. 9.

    5 AND 8

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Zhou, Y., Yang, Tb., Wei, J. et al. Single-dose intra-articular ropivacaine after arthroscopic knee surgery decreases post-operative pain without increasing side effects: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 24, 1651–1659 (2016). https://doi.org/10.1007/s00167-015-3656-y

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  • DOI: https://doi.org/10.1007/s00167-015-3656-y

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