Abstract
BackgroundSingle administration of intra-articular (IA) bupivacaine for pain relief after arthroscopic knee surgery is effective, but its active duration and dose–response relationship is unclear. We conducted this meta-analysis to summarize all published randomized controlled trials (RCTs), thus providing the most recent information on the safety and efficacy of single-administration IA bupivacaine for pain relief after arthroscopic knee surgery, and to determine whether a dose–response relationship exists.MethodsA systematic electronic literature search (through April 2014) was conducted to identify those RCTs that addressed the safety and efficacy of a single administration of IA bupivacaine for pain management after arthroscopic knee surgery. Subgroup analysis was conducted to determine changes in visual analog scale (VAS) scores at seven postoperative time points. Meta-regression and subgroup analyses were carried out to assess the effects of various treatment factors on efficacy and to evaluate the dose–response relationship of bupivacaine. Weighted mean differences or relative risks were calculated and pooled using a random-effects model.ResultsTwenty-eight trials involving 1,560 patients who underwent arthroscopic knee surgery met the inclusion criteria. The trials were subject to medium risk of bias. VAS scores at 2, 4, 6, 12, and 24 h postoperatively were significantly lower, the number of patients requiring supplementary analgesia was smaller, and the time to first request for analgesia was longer in the IA bupivacaine group than in the placebo group. The analgesic effect of single-administration IA bupivacaine may be associated with the effect of concomitant administration of epinephrine and concentration of bupivacaine, and no dose–response relationship was identified. No significant difference in side effects was detected between groups.ConclusionsCurrent evidence shows that the use of single-administration IA bupivacaine is effective for postoperative pain management in patients undergoing arthroscopic knee surgery, with satisfactory short-term safety. Low-dose administration of IA bupivacaine 0.5% combined with epinephrine adjuvant in clinical practice should be performed. Additional high-quality RCTs with longer follow-up periods are required to examine the safety of single-administration IA bupivacaine.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-015-0477-6) contains supplementary material, which is available to authorized users.
Highlights
Single administration of intra-articular (IA) bupivacaine for pain relief after arthroscopic knee surgery is effective, but its active duration and dose–response relationship is unclear
The most important findings of the present study are that 1) the analgesic effect could be associated with concomitant epinephrine and with concentration of bupivacaine, 2) there was no dose–response relationship of single-administration IA bupivacaine on the analgesic effect, and 3) the use of single-administration IA may not increase the prevalence of side effects during short-term observation
With regard to duration of analgesic effect, our metaanalysis showed that single-administration IA bupivacaine is effective for pain management for approximately 24 h following arthroscopic knee surgery, which is consistent with some previous studies [22,25,32,42]
Summary
Single administration of intra-articular (IA) bupivacaine for pain relief after arthroscopic knee surgery is effective, but its active duration and dose–response relationship is unclear. Single intra-articular (IA) administration of local anesthetic has been used to provide better analgesia after arthroscopic knee surgery and to reduce consumption and possible side effects of oral and intravenous anesthetics. The analgesic efficacy of IA bupivacaine, especially single-administration bupivacaine, has been studied because its effect on postoperative pain is conceptually simple. Despite reports supporting its use, the results of a number of studies on the efficacy of singleadministration IA bupivacaine after arthroscopic knee surgery have been equivocal [2,3]
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