Abstract
Purpose: To compare the postoperative analgesic effects of 50 mg diclofenacpo before surgery and intra-articular ropivacaine injected after diagnostic day-case knee arthroscopy performed under spinal anesthesia.
Methods: In a randomized, double-blind investigation, 200 ASA physical status 1–2 outpatients, age 18–60 yr, received either 50 mg diclofenacpo or placebo one hour before operation (100 patients per group), and intra-articular injections of either 20 ml of ropivacaine 0.5% or 20 ml of saline 0.9% (50 patients in each premedication groups). Patients received 50 mg diclofenacpo prn and, if needed, 0.1 mg·kg−1 oxycodoneim for postoperative pain relief. Patients were discharged home with a supply of 50 mg diclofenac tablets and were given a sheet of paper with knee pain VAS scales and a questionnaire of analgesics taken. Patients rated their VAs scores eight hours after surgery and in the morning and at the end of the first and the second postoperative days, respectively.
Results: The only statistically significant difference was found when the diclofenac groups were combined and compared with the combined placebo premedication groups. The VAS scores of knee pain at eight hours after the operation were 19±22 in the two diclofenac premedication groups and 32±28 in the two placebo groups (P=0.001).
Conclusions: Diclofenac premedicationpo reduced the VAS scores at eight hours postoperatively while intra-articular ropivacaine did not.
Résumé
Objectif: Comparer les effets analgésiques postopératoires de 50 mg de diclofénacpo, administrés avant l’opération, à la ropivacaïne intra-articulaire, donnée parès l’arthroscopie diagnostique sous rachianesthésie.
Méthode: Lors d’une étude randomisée et en double aveugle, 200 patients d’état physique ASA I–II, âgés de 18–60 ans, ont reçu 50 mg de diclofénacpo ou un placebo une heure avant l’opération (100 patients par groupe), et une injection intra-articulaire de 20 ml de ropivacaïne 0,5 % ou 20 ml de solution salée 0,9% (50 patients dans chaque groupe de prémédication). Les patients ont reçu 50 mg de diclofénacpo prn/it et, si nécessaire, 0,1 mg·kg−1 d’oxycodoneim pour soulager la douleur postopératorie. À leur départ, ils ont reçu des comprimés de 50 mg de diclofénac, un questionnaire concernant la prise d’analgésiques et une feuille de papier où inscrire le niveau de douleur au genou selon l’EVA. Les patients ont estimé leurs scores à l’EVA huit heures parès l’opération et au début et à la fin du premier et du deuxième jours postopératoires, respectivement.
Résultats: La seule différence statistique significative a été trouvée en combinant les groupes de diclofénac et en les comparant aux groupes combinés de prémédication placebo. Les scores postopératoires de l’EVA ont été de 19±22 dans les deux groupes qui ont reçu une prémédication de diclofénac et de 32±28 dans les groupes qui ont reçu le placebo (P=0,001).
Conclusion: La prémédication au diclofénacpo a réduit les scores postopératoires de l’EVA à huit heures, mais non pas la ropivacaïne intra-articulaire.
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References
Allen GC, St. Amand MA, Lui ACP, Johnson DH, Lindsay P. Postarthroscopy analgesia with intraarticular bupivacaine/morphine. A randomized clinical trial. Anesthesiology 1993; 79: 475–80.
McSwiney MM, Joshi GP, Kenny P, McCarroll SM. Analgesia following arthroscopic knee surgery. A controlled study of intra-articular morphine, bupivacaine or both combined. Anaesth Intensive Care 1993; 21: 201–3.
Kaeding CC, Hill JA, Katz J, Benson L. Bupivacaine use after knee arthroscopy: pharmacokinetics and pain control study. Arthroscopy 1990; 6: 33–9.
McQuay HJ, Carroll D, Moore RA Postoperative orthopaedic pain — the effect of opiate premedication and local anaesthetic blocks. Pain 1988; 33: 291–5.
Joshi GP, McCarroll SM, O’Brien TM, Lenane P. Intraarticular analgesia following knee arthroscopy. Anesth Analg 1993; 76: 333–6.
Morrow BC, Milligan KR, Murthy BVS. Analgesia following day-case knee arthroscopy-the effect of piroxicam with or without bupivacaine infiltration. Anaesthesia 1995; 50: 461–3.
Chirwa SS, MacLeod BA, Day B. Intraarticular bupivacaine (Marcaine) after arthroscopic meniscectomy: a randomized double-blind controlled study. Arthroscopy 1989; 5: 33–5.
Heard SO, Edwards WT, Ferrari D, et al. Analgesic effect of intraarticular bupivacaine or morphine after arthroscopic knee surgery: a randomized prospective, double-blind study. Anesth Analg 1992; 74: 822–6.
Henderson RC, Campion ER, DeMasi RA, Taft TN. Postarthroscopy analgesia with bupivacaine. A prospective, randomized, blinded evaluation. Am J Sports Med 1990; 18: 614–7.
Milligan KA, Mowbray MJ, Mulrooney L, Standen PJ. Intra-articular bupivacaine for pain relief after arthroscopic surgery of the knee joint in daycase patients. Anaesthesia 1988; 43: 563–4.
Sørensen TS, Sørensen AI, Strange K. The effect of intra-articular instillation of bupivacaine on postarthroscopic morbidity: a placebo-controlled, double-blind trial. Arthroscopy 1991; 7: 364–7.
Katz JA, Bridenbaugh PO, Knarr DC, Helton SH, Denson DD. Pharmacodynamics and pharmacokinetics of epidural ropivacaine in humans. Anesth Analg 1990; 70: 16–21.
Concepcion M, Arthur GR, Steele SM, Bader AM, Covino BG. A new local anesthetic, ropivacaine. Its epidural effects in humans. Anesth Analg 1990; 70: 80–5.
Scott DB, Lee A, Fagan D, Bowler GMR, Bloomfield P, Lundh R. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg 1989; 69: 563–9.
Knudsen K, Beckman Suurküla M, Blomberg S, Sjövall J, Edvardsson N. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine, and placebo in volunteers. Br J Anaesth 1997; 78: 507–14.
Breslow MJ, Jordan DA, Christopherson R, et al. Epidural morphine decreases postoperative hypertension by attenuating sympathetic nervous system hyperactivity. JAMA 1989; 26: 3577–81.
Rutherg H, Håkanson E, Anderberg B, Jorfeldt L, Mårtensson J, Schidt B. Effects of the extradural administration of morphine, or bupivacaine, on the endocrine response to upper abdominal surgery. Br J Anaesth 1984; 56: 233–8.
Tverskoy M, Cozacor C, Ayche M, Bradley EL Jr,Kissin I. Postoperative pain after inguinal herniorraphy with different types of anaesthesia. Anesth Analg 1990; 70: 29–35.
Jebeles JA, Reilly JS, Gutierrez JF, Bradley EL Jr,Kissin I. The effect of pre-incisional infiltration of tonsils with bupivacaine on the pain following tonsillectomy under general anesthesia. Pain 1991; 47: 305–8.
Raja SN, Dickstein RE, Johnson CA Comparison of postoperative analgesic effects of intraarticular bupivacaine and morphine following arthroscopic knee surgery. Anesthesiology 1992; 77: 1143–7.
Katz J, Kavanagh BP, Sandler AN, et al. Preemptive analgesia. Clinical evidence of neuroplasticity contributing to postoperative pain. Anesthesiology 1992; 77: 439–46.
Wall PD. The prevention of postoperative pain (editorial). Pain 1988; 33: 289–90.
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Rautoma, P., Santanen, U., Avela, R. et al. Diclofenac premedication but not intra-articular ropivacaine alleviates pain following day-case knee arthroscopy. ja]Can J Anaesth 47, 220–224 (2000). https://doi.org/10.1007/BF03018916
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DOI: https://doi.org/10.1007/BF03018916