Pain relief following arthroscopy: A comparative study of intra-articular bupivacaine, neostigmine, and clonidine

Abstract

Background and Aims: Quality pain relief after arthroscopic knee surgery is not only a challenge but also a necessity for adequate postoperative rehabilitation after anterior cruciate ligament (ACL) repair. In the past, different agents were tried for pain relief by parenteral and intra-articular routes with varying results. The aim of the present study is to compare the analgesic effects of intra-articularly instilled bupivacaine, clonidine, and neostigmine in the postoperative period after ACL repair. Methods: This was a double-blind study on three groups of patients, wherein bupivacaine, clonidine, or neostigmine was instilled intra-articularly at the end of knee arthroscopic ACL repair and the postprocedure pain relief was assessed. All patients received subarachnoid block with the same volume (17.5 mg) of 0.5% bupivacaine heavy. Postoperative pain was assessed with the visual analog scale (VAS), and rescue analgesics were prescribed for a more than tolerable pain. Pain score was observed at definite intervals and rescue doses were charted in crosstabs. Efficiency of the three drugs in question was tested with Bonferroni technique. Results: VAS scores at 2 h, 6 h, and 12 h were lowest with bupivacaine followed by clonidine and neostigmine. The requirement of rescue analgesics was also in the same order. Conclusion: On the basis of this study, we conclude that intra-articularly instilled bupivacaine provides superior and long-lasting analgesia than clonidine and neostigmine.