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Single-dose intra-articular bupivacaine after knee arthroscopic surgery: a meta-analysis of randomized placebo-controlled studies

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

Abstract

Purpose

The purpose of this meta-analysis was to examine the efficacy and safety of single-dose intra-articular bupivacaine in the management of pain after knee arthroscopic surgery.

Method

The comprehensive literature search, using MEDLINE, the Cochrane Central Register of Controlled Trials, and Embase databases, was conducted to identify randomized controlled trials that used single-dose intra-articular bupivacaine for postoperative pain. The relative risk (RR), weighted mean difference (WMD), and their corresponding 95 % confidence intervals (CIs) were calculated using RevMan® statistical software.

Result

Twenty-three studies (n = 1287) were included (647 subjects in bupivacaine group and 640 subjects in the control group). Statistically significant differences were observed in the VAS values (WMD −1.1; 95 % CI −1.7 to −0.5), number of patients requiring supplementary analgesia (RR 0.83; 95 % CI 0.74–0.94), and time to first analgesic request (WMD 129.3; 95 % CI 15.4–243.1) among the bupivacaine group when compared to the control group. However, short-term side effects had no significant difference between these two groups (RR 0.73; 95 % CI 0.44–1.24).

Conclusions

On the basis of the currently available literature, single-dose intra-articular bupivacaine was shown to be significantly better than placebo at relieving pain after knee arthroscopic surgery. More high-quality randomized controlled trials with long follow-up are highly required for examining the safety of single-dose intra-articular bupivacaine. Besides, routine use of single-dose intra-articular bupivacaine is still an effective way for pain management after knee arthroscopic surgery.

Level of evidence

II.

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References

  1. Aasbo V, Raeder JC, Grogaard B et al (1996) No additional analgesic effect of intra-articular morphine or bupivacaine compared with placebo after elective knee arthroscopy. Acta Anaesthesiol Scand 40:585–588

    Article  CAS  PubMed  Google Scholar 

  2. Alagol A, Calpur OU, Usar PS et al (2005) Intraarticular analgesia after arthroscopic knee surgery: comparison of neostigmine, clonidine, tenoxicam, morphine and bupivacaine. Knee Surg Sports Traumatol Arthrosc 13:658–663

    Article  CAS  PubMed  Google Scholar 

  3. Albright GA (1979) Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. J Anesth 51:285–287

    Article  CAS  Google Scholar 

  4. Ates Y, Kinik H, Binnet MS et al (1994) Comparison of prilocaine and bupivacaine for post-arthroscopy analgesia: a placebo-controlled double-blind trial. Arthroscopy 10:108–109

    Article  CAS  PubMed  Google Scholar 

  5. Batra YK, Mahajan R, Bangalia SK et al (2005) Bupivacaine/ketamine is superior to intra-articular ketamine analgesia following arthroscopic knee surgery. Can J Anaesth 52:832–836

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  7. Bjornsson A, Gupta A, Vegfors M et al (1994) Intraarticular morphine for postoperative analgesia following knee arthroscopy. Reg Anesth 19:104–108

    Google Scholar 

  8. Boden BP, Fassler S, Cooper S et al (1994) Analgesic effect of intraarticular morphine, bupivacaine, and morphine/bupivacaine after arthroscopic knee surgery. Arthroscopy 1:104–107

    Article  Google Scholar 

  9. Calmet J, Esteve C, Boada S et al (2004) Analgesic effect of intra-articular ketorolac in knee arthroscopy: comparison of morphine and bupivacaine. Knee Surg Sports Traumatol Arthrosc 12:552–555

    Article  CAS  PubMed  Google Scholar 

  10. Campo MM, Kerkhoffs GM, Sierevelt IN et al (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 Central  PubMed  Google Scholar 

  11. Cepeda MS, Uribe C, Betancourt J et al (1997) Pain relief after knee arthroscopy: intra-articular morphine, intra-articular bupivacaine, or subcutaneous morphine? Reg Anesth 22:233–238

    Article  CAS  PubMed  Google Scholar 

  12. Chirwa SS, MacLeod BA, Day B (1989) Intraarticular bupivacaine (Marcaine) after arthroscopic meniscectomy: a randomized double-blind controlled study. Arthroscopy 5:33–35

    Article  CAS  PubMed  Google Scholar 

  13. Chu CR, Izzo NJ, Coyle CH et al (2008) The in vitro effects of bupivacaine on articular chondrocytes. J Bone Joint Surg Br 90:814–820

    Article  CAS  PubMed  Google Scholar 

  14. Cook TM, Tuckey JP, Nolan JP (1997) Analgesia after day-case knee arthroscopy: double-blind study of intra-articular tenoxicam, intra-articular bupivacaine and placebo. Br J Anaesth 78:163–168

    Article  CAS  PubMed  Google Scholar 

  15. Craft DV, Good RP (1994) Delayed hypersensitivity reaction of the knee after injection of arthroscopy portals with bupivacaine (Marcaine). Arthroscopy 10:305–308

    Article  CAS  PubMed  Google Scholar 

  16. Datta R, Madhusudanan TP (2004) Pain relief following Arthroscopy: a comparative study of Intra-articular Bupivacaine, Morphine and Neostigmine. Armed Forces Med J India 60:123–127

    Article  Google Scholar 

  17. De Andres J, Valia JC, Barrera L et al (1998) Intra-articular analgesia after arthroscopic knee surgery: comparison of three different regimens. Eur J Anaesthesiol 15:10–15

    PubMed  Google Scholar 

  18. Dragoo JL, Braun HJ, Kim HJ et al (2012) The in vitro chondrotoxicity of single-dose local anesthetics. Am J Sports Med 40:794–799

    Article  PubMed  Google Scholar 

  19. Dragoo JL, Korotkova T, Kanwar R et al (2008) The effect of local anesthetics administered via pain pump on chondrocyte viability. Am J Sports Med 36:1484–1488

    Article  PubMed  Google Scholar 

  20. Dragoo JL, Korotkova T, Kim HJ et al (2010) Chondrotoxicity of low pH, epinephrine, and preservatives found in local anesthetics containing epinephrine. Am J Sports Med 38:1154–1159

    Article  PubMed  Google Scholar 

  21. Elsharnouby NM, Eid HE, Abou Elezz NF et al (2008) Intraarticular injection of magnesium sulphate and/or bupivacaine for postoperative analgesia after arthroscopic knee surgery. Anesth Analg 106:1548–1552

    Article  CAS  PubMed  Google Scholar 

  22. Eroglu A, Saracoglu S, Erturk E et al (2010) A comparison of intraarticular morphine and bupivacaine for pain control and outpatient status after an arthroscopic knee surgery under a low dose of spinal anaesthesia. Knee Surg Sports Traumatol Arthrosc 18:1487–1495

    Article  PubMed  Google Scholar 

  23. Farouk S, Aly A (2009) A comparison of intra-articular magnesium and/or morphine with bupivacaine for postoperative analgesia after arthroscopic knee surgery. J Anesth 23:508–512

    Article  PubMed  Google Scholar 

  24. Foley NC, Bhogal SK, Teasell RW, Bureau Y, Speechley MR (2006) Estimates of quality and reliability with the physiotherapy evidence-based database scale to assess the methodology of randomized controlled trials of pharmacological and nonphar-macological interventions. Phys Ther 86:817–824 (Maxillofac Surg 59:979–983, 983–984)

    Google Scholar 

  25. Geutjens G, Hambidge JE (1994) Analgesic effects of intraarticular bupivacaine after day-case arthroscopy. Arthroscopy 10:299–300

    Article  CAS  PubMed  Google Scholar 

  26. Grabowska-Gaweł A, Gaweł K, Hagner W et al (2003) Morphine or bupivacaine in controlling postoperative pain in patients subjected to knee joint arthroscopy. Ortop Traumatol Rehabil 5:758–762

    PubMed  Google Scholar 

  27. Hansen TB, Jakobsen IA (2008) Intra-articular bupivacaine as treatment for postoperative pain after arthroscopy of the wrist. Scand J Plast Reconstr Surg Hand Surg 42:313–315

    Article  PubMed  Google Scholar 

  28. Haynes TK, Appadurai IR, Power I et al (1994) Intra-articular morphine and bupivacaine analgesia after arthroscopic knee surgery. Anaesthesia 49:54–56

    Article  CAS  PubMed  Google Scholar 

  29. Henderson RC, Campion ER, DeMasi RA et al (1990) Postarthroscopy analgesia with bupivacaine. A prospective, randomized, blinded evaluation. Am J Sports Med 18:614–617

    Article  CAS  PubMed  Google Scholar 

  30. Izdes S, Orhun S, Turanli S et al (2003) The effects of preoperative inflammation on the analgesic efficacy of intraarticular piroxicam for outpatient knee arthroscopy. Anesth Analg 97:1016–1019

    Article  PubMed  Google Scholar 

  31. Karamanlioğlu B, Alagöl A, Turan FN (2005) Preemptive oral rofecoxib plus postoperative intraarticular bupivacaine for pain relief after arthroscopic knee surgery. Agri 17:29–33

    PubMed  Google Scholar 

  32. Khoury GF, Chen AC, Garland DE et al (1992) Intraarticular morphine, bupivacaine, and morphine/bupivacaine for pain control after knee videoarthroscopy. Anesthesiology 77:263–266

    Article  CAS  PubMed  Google Scholar 

  33. Koltka K, Koknel-Talu G, Asik M et al (2011) Comparison of efficacy of intraarticular application of magnesium, levobupivacaine and lornoxicam with placebo in arthroscopic surgery. Knee Surg Sports Traumatol Arthrosc 19:1884–1889

    Article  PubMed  Google Scholar 

  34. Liberati A, Altman DG, Tetzlaff J et al (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 

  35. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M (2003) Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 83:713–721

    PubMed  Google Scholar 

  36. Marchal JM, Delgado-Martinez AD, Poncela M et al (2003) Does the type of arthroscopic surgery modify the analgesic effect of intraarticular morphine and bupivacaine? A preliminary study. Clin J Pain 19:240–246

    Article  PubMed  Google Scholar 

  37. Marret E, Gentili M, Bonnet MP et al (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 

  38. Miller AC (2008) A review of open and closed kinetic chain exercises following anterior cruciate ligament reconstruction; http://www.brianmac.demon.co.uk/kneeinj.htm

  39. Milligan KA, Mowbray MJ, Mulrooney L et al (1988) Intra-articular bupivacaine for pain relief after arthroscopic surgery of the knee joint in daycase patients. Anaesthesia 43:563–564

    Article  CAS  PubMed  Google Scholar 

  40. Morgenthaler K, Bauer C, Ziegeler S et al (2007) Intra-articular bupivacaine following hip joint arthroscopy. Effect on postoperative pain. Anaesthesist 56:1128–1132

    Article  CAS  PubMed  Google Scholar 

  41. Møiniche S, Mikkelsen S, Wetterslev J et al (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  PubMed  Google Scholar 

  42. Osborne D, Keene G (1993) Pain relief after arthroscopic surgery of the knee: prospective, randomized, and blinded assessment of bupivacaine and bupivacaine with adrenaline. Arthroscopy 9:177–180

    Article  CAS  PubMed  Google Scholar 

  43. Park J, Sutradhar BC, Hong G et al (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 

  44. Pavlin DJ, Chen C, Penaloza DA et al (2004) A survey of pain and other symptoms that affect the recovery process after discharge from an ambulatory surgery unit. J Clin Anesth 16:200–206

    Article  PubMed  Google Scholar 

  45. Piper SL, Kim HT (2008) Comparison of ropivacaine and bupivacaine toxicity in human articular chondrocytes. J Bone Joint Surg Am 90:986–991

    Article  PubMed  Google Scholar 

  46. Raja SN, Dickstein RE, Johnson CA (1992) Comparison of postoperative analgesic effects of intraarticular bupivacaine and morphine following. Anesthesiology 77:1143–1147

    Article  CAS  PubMed  Google Scholar 

  47. RapleyJH Beavis RC, Barber FA (2009) Glenohumeral chondrolysis after shoulder arthroscopy associated with continuous bupivacaine infusion. Arthroscopy 25:1367–1373

    Article  Google Scholar 

  48. Reuben SS, Sklar J (2000) Pain management in patients who undergo outpatient arthroscopic surgery of the knee. J Bone Joint Surg Am 82:1754–1766

    PubMed  Google Scholar 

  49. Ruwe PA, Klein I, Shields CL (1995) The effect of intraarticular injection of morphine and bupivacaine on postarthroscopic pain control. Am J Sports Med 23:59–64

    Article  CAS  PubMed  Google Scholar 

  50. Senthilkumaran S, Tate R, Read JRM et al (2010) Intra-articular morphine and bupivacaine for post-operative analgesia in anterior cruciate ligament reconstruction: a prospective randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 18:731–735

    Article  CAS  PubMed  Google Scholar 

  51. Shelbourne KD, Nitz P (1992) Accelerated rehabilitation after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 15:256–264

    Article  CAS  PubMed  Google Scholar 

  52. Smith I, Van Hemelrijck J, White PF et al (1991) Effects of local anesthesia on recovery after outpatient arthroscopy. Anesth Analg 73:536–539

    CAS  PubMed  Google Scholar 

  53. 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 

  54. St-Pierre DM (1995) Rehabilitation following arthroscopic meniscectomy. Sports Med 20:338–347

    Article  CAS  PubMed  Google Scholar 

  55. Toivonen J, Pitko VM, Rosenberg PH (2002) Comparison between intra-articular bupivacaine with epinephrine and epinephrine alone on short-term and long-term pain after knee arthroscopic surgery under general anesthesia in day-surgery patients. Acta Anaesthesiol Scand 46:435–440

    Article  CAS  PubMed  Google Scholar 

  56. Tompkins M, Plante M, Monchik K et al (2011) The use of a non-benzodiazepine hypnotic sleep-aid (Zolpidem) in patients undergoing ACL reconstruction: a randomized controlled clinical trial. Knee Surg Sports Traumatol Arthrosc 19:787–791

    Article  PubMed  Google Scholar 

  57. Varrassi G, Marinangeli F, Ciccozzi A et al (1999) Intra-articular buprenorphine after knee arthroscopy: a randomised, prospective, double-blind study. Acta Anaesthesiol Scand 43:51–55

    Article  CAS  PubMed  Google Scholar 

  58. Webb ST, Ghosh S (2009) Intra-articular bupivacaine: potentially chondrotoxic? Br J Anaesth 102:439–441

    Article  CAS  PubMed  Google Scholar 

  59. Zeidan A, Kassem R, Nahleh N et al (2008) Intraarticular tramadol-bupivacaine combination prolongs the duration of postoperative analgesia after outpatient arthroscopic knee surgery. Anesth Analg 107:292–299

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Tu-bao Yang.

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Wei, J., Yang, Hb., Qin, Jb. et al. 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 (2014). https://doi.org/10.1007/s00167-013-2543-7

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