Analgesia In Arthroscopic Knee Surgery Research Articles

Imrecoxib versus celecoxib as postoperative analgesia for patients receiving arthroscopic knee surgery: a randomized, controlled, non-inferiority study.

Imrecoxib is a novel cyclooxygenase-2 inhibitor independently developed in China, which exhibits a good efficacy and tolerance in orthopedic disorders. The current study aimed to further compare its efficacy and safety with celecoxib as postoperative analgesia in arthroscopic knee surgery (AKS). Patients receiving AKS were enrolled and randomly assigned to imrecoxib (n = 64) and celecoxib (n = 62) group to receive analgesia for 72h after surgery. Pain at rest and movement, pethidine consumption, patient's satisfaction, Lysholm score, and adverse events were assessed after AKS. Meanwhile the upper limit of 95% CI of pain-score mean difference (MD) between imrecoxib and celecoxib was calculated, then, the non-inferiority was defined if the all-time-point upper limits of 95% CI less than 1. Imrecoxib was non-inferior to celecoxib for alleviating pain at rest (upper limit of 95% CI of MD ranging from 0.443 to 0.782, all time-point values less than 1); as well as for attenuating pain at movement (upper limit of 95% CI of MD ranging from 0.398 to 0.582, all time-point values less than 1). Moreover, rescue analgesia rate (P = 0.583), pethidine consumption (P = 0.454), patient's satisfaction at 72h (P = 0.408), and Lysholm score at M3 (P = 0.776) were of no difference between imrecoxib group and celecoxib group. Additionally, the main adverse events in two groups were nausea (P = 0.425), constipation (P = 1.000), vomiting (P = 0.715), headache (P = 1.000), and dizziness (P = 0.667), which were mild and manageable. Imrecoxib is non-inferior to celecoxib in postoperative analgesia and exhibits an acceptable tolerance in patients undergoing AKS.

Dexamethasone and Dexmedetomidine as an Adjuvant to Intraarticular Bupivacaine for Postoperative Pain Relief in Knee Arthroscopic Surgery: A Randomized Trial

Background: Knee arthroscopy causes minimal trauma, however, good analgesia is required for early rehabilitation and return to normal life in the patients. Objective: We aimed to compare the analgesic effects of intraarticular dexamethasone and dexmedetomidine added to bupivacaine with those of bupivacaine alone. Study Design: This study uses a double-blind, randomized, controlled design with allocation concealment in a 3-armed parallel group format among patients undergoing arthroscopic meniscal surgery. Setting: The study was conducted at Assiut University Hospital in Asyut, Egypt. The study duration was from July 2016 to February 2017. Methods: After the ethics committee approval, 60 patients, with the American Society of Anesthesiologists (ASA) physical status of I or II, 20 – 50 years old, and scheduled for arthroscopic meniscal surgery were randomized in a double-blind manner to receive 18mL intraarticular bupivacaine 0.25% with either dexamethasone 8 mg (group I), dexmedetomidine 1 μg/kg (group II), or 2 mL of normal saline (group III). The total volume of injectate used in each group was 20 mL. All of the patients received spinal anesthesia. Postoperatively, oral paracetamol 1000 mg was given every 8 hours, and oral tramadol 50 mg was administered, as needed, for rescue analgesia. The visual analog scale (VAS) pain scores, time to first analgesic request, and total dose of postoperative analgesics were recorded for 3 days postoperatively. Results: The VAS scores were lower in groups I and II compared with group III. The time to the first analgesic was significantly shorter in group III compared with groups I and II (P = 0.001). The total dose of rescue paracetamol was higher in group III compared with groups I and II (P = 0.001). No need for tramadol rescue analgesia was recorded in any of the groups. No significant differences between groups I and II were noticed. Limitations: The limitations of this study include the lack of previous research to compare the effect of both intraarticular dexamethasone and dexmedetomidine added to bupivacaine for postoperative analgesia in arthroscopic knee surgery. Additionally, there was a short observation period for the detection of chondrotoxicity, if occurred. Conclusion: The addition of dexamethasone or dexmedetomidine to a solution of bupivacaine 0.25% provided better analgesia than using bupivacaine alone. Clinical trial registration: NCT02818985. Key words: Intraarticular, knee arthroscopy, bupivacaine, dexmedetomidine, dexamethasone, postoperative pain

The efficacy and safety of early initiation of preoperative analgesia with celecoxib in patients underwent arthroscopic knee surgery: A randomized, controlled study.

This study aimed to investigate the efficacy and safety of celecoxib 24 hours preoperative, 1 hour preoperative, and 4 hours postoperative administration in patients with arthroscopic knee surgery (AKS).In all, 206 patients who underwent AKS were consecutively recruited and randomized into 3 groups: (1) early preoperative analgesia group (EPEA), celecoxib 400 mg 24 hours preoperative administration; (2) preoperative analgesia group (PEA), celecoxib 400 mg 1 hour preoperative administration; (3) postoperative analgesia group (POA), celecoxib 400 mg 4 hours postoperative administration. Pain visual analog scale (VAS) scores (at rest and at 90o flexion) and patient global assessment (PGA) score were evaluated before and after operation, and also pethidine consumption and adverse events (AEs).The pain-rest VAS score, percentage of patients with moderate-severe pain at rest, and PGA score in the EPEA and PEA groups were decreased compared with POA group at 8 and 12 hours postoperation. Besides, pain-flexion to 90o VAS score in EPEA and PEA groups were also reduced compared with POA group at 8 hours postsurgery. Interestingly, the percentage of patients with moderate-severe pain at 90o flexion at 8 hours postsurgery in PEA group was fewer compared with POA group, whereas at 4 hours postoperation it was reduced in EPEA group compared with PEA and POA groups. As to consumption of pethidine, it was numerically decreased in EPEA and PEA groups compared with POA group. No difference between each 2 groups was found in AEs.Celecoxib was effective and safe as pre-emptive analgesia in AKS, and 1 hour administration before operation might be an optimal choice.

Intra-articular dexmedetomidine and clonidine for postoperative analgesia in arthroscopic knee surgery

<p class="abstract"><strong>Background:</strong> Many drugs have been used for postoperative pain management which is a common and distressing symptom after knee arthroscopy. But no single ideal intra-articular drug has been found. This study was done to assess the efficacy of intra-articular dexmedetomidine and clonidine for postoperative pain relief in patients undergoing arthroscopic knee surgeries<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> Fifty patients of American Society of Anaesthesiologists of grade I/II, aged 20-70 years posted for arthroscopic knee surgery were randomly divided into groups I (clonidine group) and group II (dexmedetomidine group). 25 patients in group I received 1 µg/ kg of clonidine diluted to 20 ml in normal saline and group II patients received 1 µg/kg of dexmedetomidine diluted to 20 ml in normal saline via intra-articular route at the end of the surgery. Visual analogue score (VAS), time to give the first dose of analgesia and total dose of analgesic required in first 24 hours was evaluated in each group.<strong></strong></p><p class="abstract"><strong>Results:</strong> VAS score was lower and time to first analgesic requirement was greater in Group II in comparison to Group I which was statistically significant. Total dose of analgesic used in Group II patients was significantly less compared to patients in Group I which was statistically significant<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Intra-articular dexmedetomidine is more effective in providing prolonged postoperative analgesia after arthroscopic knee procedures and reduces the total dose of analgesic required postoperatively compared to clonidine<span lang="EN-IN">.</span></p><p class="abstract"> </p>

Efficacy of intra-articular dexmedetomidine for postoperative analgesia in arthroscopic knee surgery done under spinal anesthesia

Background: Postoperative pain is a common and distressing symptom after knee arthroscopy. This study aims at analyzing the efficacy of intra-articular dexmedetomidine for postoperative pain relief in patients undergoing arthroscopic knee procedures under unilateral spinal anesthesia. Materials and Methods: Fifty adult patients of American Society of Anaesthesiologists Class 1-2, aged 20-60 years posted for arthroscopic knee surgery were randomly divided into Groups I (control group) and II (dexmedetomidine group) with 25 patients in each group. Anesthetic technique used was unilateral spinal in all the patients. Group I was the control group and Group II the dexmedetomidine group. Group II patients received 1 μg/kg dexmedetomidine diluted to 20 ml in normal saline via intra-articular route at the end of the procedure and Group I patients received an equal volume of normal saline. Visual analog scale (VAS) score for 24 h, time to give the first dose of analgesia and total dose of analgesic required in each group was evaluated. Results: VAS scores were significantly lower in Group II, time to first analgesic requirement was significantly greater in Group II (308 ± 3.59) than in Group I (244 ± 2.92), P < 0.001 and total dose of analgesic used in Group II (36 mg ± 7.65) patients was significantly lesser compared to patients in Group I (129 mg ± 6.87), P < 0.001. Conclusion: Intra-articular dexmedetomidine is effective in providing prolonged postoperative analgesia after arthroscopic knee procedures and reduces the total dose of analgesic required postoperatively.

Efficacy of intra-articular dexmedetomidine for postoperative analgesia in arthroscopic knee surgery

Various drugs are administered intraarticularly to provide postoperative analgesia after arthroscopic knee surgery, of which opioids and alpha2 agonists could be of particular interest. Sixty patients undergoing elective knee arthroscopy were randomly assigned to two groups (n = 30). Group R received 19 ml of 0.25% ropivacaine and 1 ml of isotonic saline (total volume 20 ml) intraarticularly. Group RD received 100 microg (1 ml) of dexmedetomidine added to 19 ml of 0.25% ropivacaine intra-articularly (total volume 20 ml). Analgesic effect was evaluated by measuring pain intensity (VAS score) and duration of analgesia. A longer delay was observed between intraarticular injection of study medication and first requirement of supplementary analgesic in group RD (10.84 +/- 2.6 hours) compared to group R (5.38 +/- 1.4 hours). Total consumption of fentanyl citrate in postoperative period was significantly less in group RD. No significant side effects were noted. Dexmedetomidine, added as adjunct to ropivacaine in patients undergoing arthroscopic knee surgery, improve the quality and duration of postoperative analgesia.

Intra-articular magnesium is effective for postoperative analgesia in arthroscopic knee surgery

Several medications are commonly injected intra-articularly for postoperative analgesia after arthroscopic knee surgery. Among the potentially efficient substances, magnesium could be of particular interest through its NMDA-receptor blocking properties. A total of 60 patients undergoing arthroscopic knee surgery were randomly and double-blindly assigned to two groups to receive intra-articular injection of either 10 ml of magnesium sulphate (MgSO(4)) (50 mg ml(-1)) (Group M) or 10 ml of normal saline (Group C). Analgesic effect was evaluated by measuring pain intensity (visual analogue scale; VAS) 1, 2, 6, 8, 12, 18 and 24 h after operation and the time delay between MgSO(4) or saline administration and the first requirement of supplementary analgesic medication by the patient (diclofenac). Intra-articular magnesium administration resulted in a significant reduction in pain scores in Group M compared with Group C 1, 2, 6 and 8 h after the end of surgery [1.7 (0.59), 2.2 (0.69), 2.8 (1.01) and 3.5 (1.10) in Group M; 8.0 (1.25), 5.9 (1.12), 4.4 (0.67) and 4.5 (1.13) in Group C, respectively]. A longer delay between intra-articular injection of the study medication and first administration of diclofenac was observed in Group M [667 (198) min] as compared with Group C [49 (13) min]. Total diclofenac consumption was significantly lower in Group M [37.5 (38.14) mg] than in Group C [117.5 (46.95) mg]. No early side-effects were noted. Intra-articular magnesium is effective for postoperative analgesia in arthroscopic knee surgery.