Effectiveness of preemptive intra-articular levobupivacaine on pain relief after arthroscopic knee surgery

Abstract

Background and Aim: Severe pain and comfortlessness may be seen in patients after arthroscopic knee surgery despite various commonly administered analgesic methods, particularly based on local anesthetics. The aim of this study was to determine the effect of intraarticular levobupivacaine injected preoperatively on pain relief and time to first analgesic request during the postoperative period. Material and Methods: 40 adult-patients, ASA I and II, undergoing elective arthroscopic surgery were included in the study. Patients in the levobupivacaine group received intra-articular levobupivacaine at 5mg/ml dosages and 20 ml total volume 30 min before the procedure. Patients in the control group received 20 ml of normal saline. Visual analogue scale (VAS) scores were assessed at the 1st, 2nd, 4th, 8th, 12th and 24th hour postoperatively. Time to first analgesic request and total analgesics used over the course of 24 hours after the surgery were recorded. All patients received continuous morphine infusion via patient controlled analgesia (PCA) devices postoperatively. Additionally, patients’ pain satisfaction scores were recorded. Results: Lower VAS scores at the 1st, 2nd, 4th and 8th hours postoperatively - both at rest and during motion - were found in the levobupivacaine group compared to the normal saline group (p<0.001, p<0.001, p<0.001 and p<0.02 respectively). Time to first analgesic request was longer with the levobupivacaine group than the group with saline (22.50 vs 15.00 min, p<0.02). A significant difference was found in consumed total opioid doses (9.10 vs 31.75 mg, p<0.001). The number of analgesic demands using PCA were significantly different between groups (10.80 v.s. 36.1 times in 24 hours, p<0.001). Conclusion: Preemptive analgesia using intraarticular levobupivacaine 5 mg/ml (20 ml total volume) provides better pain control - evaluated through VAS scoring, time to first analgesic request and opioid consumption - compared to saline in patients undergoing arthroscopic knee surger