Intra-articular Bupivacaine Research Articles

Intra-Articular Local Anesthetics in Temporomandibular Disorders: A Systematic Review and Meta-Analysis.

This systematic review with meta-analysis was conducted to evaluate the effectiveness of local anesthetic administration into temporomandibular joint cavities in relieving pain and increasing mandibular mobility. Randomized controlled trials were included with no limitation on report publication dates. Final searches were performed on 15 October 2023, using engines provided by the US National Library, Bielefeld University, and Elsevier Publishing House. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Articular pain and mandible abduction values and their mean differences were summarized in tables and graphs. Eight studies on a total of 252 patients evaluating intra-articular administration of articaine, bupivacaine, lidocaine, and mepivacaine were included in the systematic review. None of the eligible studies presented a high risk of bias in any of the assessed domains. An analgesic effect of intra-articular bupivacaine was observed for up to 24 h. In the long-term follow-up, there were no statistically significant changes in quantified pain compared to both the baseline value and the placebo group, regardless of the anesthetic used (articaine, bupivacaine, and lidocaine). There is no scientific evidence on the effect of intra-articular administration of local anesthesia on the range of motion of the mandible. Therefore, in the current state of knowledge, the administration of local anesthetics into the temporomandibular joint cavities can only be considered as a short-term pain relief measure.

A Comparative Evaluation of Intra-articular Bupivacaine vs Bupivacaine and Dexmedetomidine for Postoperative Analgesia in Arthroscopic Knee Surgeries.

Background The studywas done to determinethe duration of postoperative analgesia brought on by incorporating intra-articular Bupivacaine with Dexmedetomidine as an adjuvant following knee arthroscopies. Methods A prospective randomized control study was conducted on 60 patients of ASA classes I and II, between the ages of 20 and 60 years, undergoing arthroscopic surgeries of the knee under spinal anaesthesia. The patients were divided into group B and group D, each containing 30 patients. The participants in group B were administered Inj. Bupivacaine 0.5% 19 mL + 1 mL of normal saline intra-articularly and the participants in group D were administered Inj. Bupivacaine 0.5% 19 mL, Inj. Dexmedetomidine 1 μg/kg and normal saline post-surgery. Thenumber of analgesics used in the first 24 hours, pain levels using the visual analogue scale and the timing of administration of the first analgesic dose between the two study groups were evaluated. Results In comparison to the Bupivacaine group, the Dexmedetomidine group required fewer rescue analgesics. The visual analogue visual scale score in group B at four hours and six hours was 2.7 ± 1.39 and2.9 ± 1.03, respectively, and in group D at four hours and six hours was 1.9 ± 1.09 and 1.83 ± 0.91. The visual analoguescale scores at these times were statistically significant. The visual analogue scale scores at 12 hours and 24 hours were statistically not significant. Conclusion Dexmedetomidine added to Intra-articular Bupivacaine provides an increased duration of postoperative analgesia in patients undergoing arthroscopic surgeries of the knee. The combination offers improved analgesia and reduces the overall dosage of rescue analgesics needed without causing substantial side effects.

Is there a difference in the analgesic response to intra-articular bupivacaine injection in people with knee osteoarthritis pain with or without central sensitisation? Protocol of a feasibility randomised controlled trial

IntroductionPain is the main symptom of osteoarthritis (OA) with approximately 50% of patients reporting moderate-to-severe pain. Total knee replacement (TKR) is the ultimate treatment option to alleviate pain in knee...

Patient characteristics cannot predict the long-term effect of an intra-articular bupivacaine and corticosteroid injection in patients with femoroacetabular impingement: A retrospective cohort study

BackgroundTo evaluate predictors for effect of an intra-articular (IA) bupivacaine and corticosteroid injection in patients with femoroacetabular impingement syndrome (FAIS). MethodsAll patients between 18 and 50 years old with FAIS who received an intra-articular (IA) bupivacaine and corticosteroid injection between 2016 and 2019 were eligible for this retrospective study. Two groups were made, the non-arthroscopy group (patients for whom conservative treatment with physiotherapy and an IA bupivacaine and corticosteroid injection was sufficient) and the arthroscopy group (patients who needed an arthroscopy because conservative treatment and an IA bupivacaine and corticosteroid injection failed). Multiple regression analysis was performed to analyse the effect of the IA corticosteroid injection and to predict arthroscopic intervention based on sex, age, body mass index, duration of complaints, alpha angle and abnormal bone morphology. ResultsIn total 103 patients were included; 46 in the arthroscopy group and 57 in the non-arthroscopy group. The groups had similar baseline characteristics. A total of 37 (36%) patients had an effect of 3 months or longer from the IA corticosteroid injection; 31 (54%) were patients in the non-arthroscopy group versus 6 (13%) patients in the arthroscopy group (P < 0.001). Male sex seems to have an negative influence on the duration of the effect of the injection. None of the variables could significantly predict if a patient would undergo arthroscopic intervention (F(7,103) = 8.54, p = 0.3, R2 = 0.11). The effect of the IA injection could not be predicted (p = 0.1; R2 = 0.13). ConclusionThere are no patient characteristics that predict who would and who would not benefit from the IA bupivacaine and corticosteroid injection in patients with FAIS and who would need an arthroscopic intervention within 1 year after the injection. Only male sex seems to have an negative influence on the duration of the effect of the injection.

COMPARISON OF INTRA-ARTICULAR INJECTION OF MORPHINE VERSUS DEXMEDETOMIDINE AS AN ADJUVANT TO BUPIVACAINE IN ARTHROSCOPIC KNEE SURGERIES FOR POST-OPERATIVE ANALGESIA: A RANDOMISED DOUBLE BLINDED STUDY

Objective Despite its proven pain-relieving properties, the analgesic effect of intra-articular bupivacaine when administered without adjuvants remains short-lived. The aim of this study was to compare intra-articular injection of Morphine versus Dexmedetomidine as an adjuvant to bupivacaine in arthroscopic knee surgeries for post-operative analgesia Methods A randomized double blinded study was conducted in 60 adults of American Society of Anaesthesiologists (ASA) I &amp; II undergoing elective arthroscopic knee surgery. Patients were randomized to receive morphine 5mg (group M) or dexmedetomidine 1microgram/kg (group D) in combination with bupivacaine 0.25% 19cc. Vitals, Ramsay sedation score and VAS were monitored. Diclofenac Sodium (75mg) was administered intravenously as rescue analgesic at VAS &gt;3. Time to rst request of analgesic and dosage of total analgesic consumption in 24 hours were recorded. Adverse effects, if any were noted. Cases in group M had Results adequate analgesia for 16.20 ± 3.75 hours which was signicantly higher (p value &lt;0.001) than those in group D, that lasted for 9.47 ± 1.36 hours. Total number of analgesic injections required were higher in Group D than in group M (p value &lt;0.001). In group M, none had any side effects while 2 out of 30 in group D had hypotension and urinary retention respectively. Conclusion Combination of intra-articular morphine with bupivacaine provides better analgesia than with dexmedetomidine with prolongation of time required to use rescue analgesic in post-arthroscopic knee surgery.

Dexmedetomidine versus tramadol as adjuvant to bupivacaine in intra-articular injection after knee arthroscopy: A prospective control randomized trial.

Evaluating the time to the first request of rescue analgesic after adding either dexmedetomidine or tramadol to intraarticular bupivacaine. A prospective, randomized, control, double-blinded study. Operating room at Tanta University Hospital. Sixty adult patients were enrolled and scheduled for knee arthroscopic surgery. Post-operative intra-articular injection of dexmedetomidine 1 µg/kg or tramadol 100 mg compared with a control group receiving intra-articular bupivacaine alone. The time to the first request of rescue analgesic, total consumption of analgesic, and post-operative numeric rating scale at 1, 3, 6, 9, 12, and 24 hours post-operatively. The time to the first request of analgesia was comparable between group D and group T with p value 0.84, but it was significantly shorter in group T and group D in comparison with group C, with p value 0.001 for both. Post-operative 24 hours morphine consumption was also comparable between group D and group T with p value 0.17, but it was significantly lower in group T and group D in comparison with group C, with p value 0.001 for both. There was also no significant difference in numeric rating scale between dexmedetomidine group and tramadol group over the 24 hours of the study, but numeric rating scale values were significantly higher in the control group. The incidence of nausea and vomiting was comparable among the three groups. All patients displayed a stable hemodynamic profile. Adding either dexmedetomidine or tramadol as a single dose to intra-articular bupivacaine resulted in the prolongation of the time to the first request of analgesic and reduced the incidence of post-operative pain and post-operative morphine requirement, when compared with the groups receiving intra-articular bupivacaine alone.

A Comparative Evaluation of Intra-Articular Bupivacaine vs Bupivacaine and Dexmedetomidine for Postoperative Analgesia in Arthroscopic Knee Surgeries: A Study Protocol

Background: Various degrees of pain is seen in the post-operative period following almost every arthroscopic knee surgery. The reason behind this pain is due to the irritation that occurs to the nerve endings that are found free in the synovium of the knee. Hence, to make this difficult period pain free various analgesics are given to the patient. They are given through various routes and they may be given as sole analgesics or in combination. One such routes used is the intra-articular route in which analgesics are given intra-articularly for post -operative analgesia. Dexmedetomidine is a drug which can be used the aforementioned route. The main of this study is to evaluate the effectiveness of Intra-articular Dexmedetomidine as an adjuvant to Intra-articular Bupivacaine.&#x0D; Aim: This study aims to compare Intra-articular Bupivacaine vs Bupivacaine and Dexmedetomidine for prolonging post-operative analgesia following knee arthroscopy surgery.&#x0D; Objectives: The primary objective is to assess the duration of postoperative analgesia produced by Dexmedetomidine when used as an adjuvant to Intra-articular Bupivacaine after arthroscopic knee surgeries. The secondary objectives are to evaluate Dexmedetomidine as an adjuvant to Intra-articular Bupivacaine, with respect to:&#x0D; &#x0D; Quality of analgesia,&#x0D; Number of doses of rescue analgesic required during study period,&#x0D; Systemic/Local side effects.&#x0D; &#x0D; Methods: 60 patients within the age group 20-60 undergoing arthroscopic knee surgeries will be enrolled for the study. Following the completion of surgery, patients allotted to Group B will receive 19ml of Intra-articular Bupivacaine with 1ml of normal saline and patients allotted to Group D will receive 19 ml of Intra-articular Bupivacaine with 1mcg/kg Dexmedetomidine. Post-operative analgesia will be monitored using VAS and the requirement of rescue analgesics in both groups will be noted down and compared.&#x0D; Expected Outcomes: The VAS and total requirement of rescue analgesics is expected to be less in Group D with minimal/no side effects.

In vitro and in vivo Effects of a Single Dose of Bupivacaine 5% on Donkey Chondrocytes.

Single intra-articular (IA) injection of long-acting local anesthetics such as bupivacaine is commonly used clinically for postoperative analgesia, in particular, after arthroscopic surgery. Despite their widespread use, the side effects of IA bupivacaine on joint cartilage as well as hepatotoxic and nephrotoxic effects remain to be elucidated. The aim of this study is to assess the in vitro effect of bupivacaine 5% on donkey chondrocytes at different time points, in addition to the in vivo effects of a single IA bupivacaine injection on the middle carpal joint in a group of 10 clinically healthy adult male donkeys. In phase I, the effect of in vitro treatment with bupivacaine 5% or saline 0.9% on freshly isolated donkey chondrocytes for 30, 60 min, 24, 48, and 96 h was investigated using MTT and LIVE/DEAD assay. In phase II, in vivo effects of single injection of bupivacaine on the middle carpal joint of the donkey were evaluated compared with saline 0.9%. Biochemical analysis of collected serum and synovia was performed. Additionally, articular cartilage damage was evaluated using radiography, computed tomography (CT), catabolic marker expression via quantitative polymerase chain reaction (qPCR), and histopathological examination 96 h after injection. Our results showed that after a 30-min exposure to bupivacaine 5%, the viability of donkey chondrocytes was 97.3 ± 4.4% and was not significantly affected at the indicated time points (n = 8, p < 0.05). No significant changes in biochemical analytes of serum and synovial fluid following IA bupivacaine injection were observed, compared with saline injection (n = 5 for each group, p < 0.05). Furthermore, in vivo IA injection of bupivacaine revealed no significant differences in radiography, CT scan, gene expression of cartilage catabolic biomarkers, and histopathological examination. These results provide an evidence for the safety of bupivacaine on the donkey cartilage.

Impact of dexamethasone added to intra-articular morphine and bupivacaine for postoperative analgesia after knee arthroscopy

BackgroundPain relief after knee arthroscopy is very important for early recovery and rehabilitation. The study was conducted to evaluate the effects of adding dexamethasone (8 mg) to intra-articular morphine (10 mg) and bupivacaine (25 mg) combination on postoperative pain after knee arthroscopy.ResultsWe enrolled 40 patients, 18–65 years-old of both sexes, ASA I and II scheduled for minor arthroscopic knee surgeries. The study group showed a lower visual analog score at rest and movement, prolonged postoperative analgesia, and decreased total analgesic consumption compared with the control group (P value < 0.05).ConclusionsAdding dexamethasone to intra-articular combination of morphine and bupivacaine after knee arthroscopy prolongs the duration of analgesia, lowers pain scores, and decreases total analgesic consumption with no detected adverse effects.

In Vitro Effects of Bupivacaine on the Viability and Mechanics of Native and Engineered Cartilage Grafts

Background: Although the toxic effects of bupivacaine on chondrocyte monolayer culture have been well described, its cellular and mechanical effects on native and engineered articular cartilage remain unclear. For the repair of articular cartilage defects, fresh autologous and allogenic cartilage grafts are commonly used, and engineered cell-based therapies are emerging. The outcome of grafting therapies aimed at repairing damaged cartilage relies largely on maintaining proper viability and mechanical suitability of the donor tissues. Purpose: To investigate the in vitro effects of single bupivacaine exposure on the viability and mechanics of 2 cartilage graft types: native articular cartilage and engineered neocartilage. Study Design: Controlled laboratory study. Methods: Articular cartilage explants were harvested from the bovine stifle femoral condyles, and neocartilage constructs were engineered from bovine stifle chondrocytes using the self-assembling process, a scaffold-free approach to engineer cartilage tissue. Both explants and neocartilage were exposed to chondrogenic medium containing a clinically applicable bolus of 0.5%, 0.25%, or 0% (control) bupivacaine for 1 hour, followed by fresh medium wash and exchange. Cell viability and matrix content (collagen and glycosaminoglycan) were assessed at t = 24 hours after treatment, and compressive mechanical properties were assessed with creep indentation testing at t = 5 to 6 days after treatment. Results: Single bupivacaine exposure was chondrotoxic in both explants and neocartilage, with 0.5% bupivacaine causing a significant decrease in chondrocyte viability compared with the control condition (55.0% ± 13.4% vs 71.9% ± 13.5%; P < .001). Bupivacaine had no significant effect on matrix content for either tissue type. There was significant weakening of the mechanical properties in the neocartilage when treated with 0.5% bupivacaine compared with control, with decreased aggregate modulus (415.8 ± 155.1 vs 660.3 ± 145.8 kPa; P = .003), decreased shear modulus (143.2 ± 14.0 vs 266.5 ± 89.2 kPa; P = .002), and increased permeability (14.7 ± 8.1 vs 6.6 ± 1.7 × 10−15 m4/Ns; P = .009). Bupivacaine exposure did not have a significant effect on the mechanical properties of native cartilage explants. Conclusion: Single bupivacaine exposure resulted in significant chondrotoxicity in native explants and neocartilage and significant weakening of mechanical properties of neocartilage. The presence of abundant extracellular matrix does not appear to confer any additional resistance to the toxic effects of bupivacaine. Clinical Relevance: Clinicians should be judicious regarding the use of intra-articular bupivacaine in the setting of articular cartilage repair.

Efficacy and Safety of Lidocaine Patch 5% Supplementation to Intra-articular Bupivacaine Dexmedetomidine after Knee Arthroscopy under General Anesthesia: A Randomized Controlled Study

ABSTRACT Background: Adequate pain management after knee arthroscopy (KA) under general anesthesia (GA) is often problematic. Therefore, we evaluated the efficacy and safety of lidocaine patch 5% (LP5) supplementation to intra-articular (IA) bupivacaine and dexmedetomidine after KA under GA.Methods: This randomized controlled study was conducted on 40 adult patients undergoing KA under GA. Patients were randomized into two groups (20 patients in each). At the end of the surgery, group A received an IA injection of 10 ml bupivacaine 0.5% and 1 µg/kg dexmedetomidine diluted in 10 ml saline. Group B received as group A, and one LP5 (700 mg) applied at the portal site for 12 h postoperatively. Intravenous pethidine 20 mg was administered if the postoperative visual analogue scale (VAS) was ≥4.Results: The postoperative pethidine consumption in the first 24 h was significantly lower in group B. The time of the first request of analgesia and number of patients discharged at 24 h were significantly higher in group B. Heart rate, mean arterial pressure, and VAS were significantly higher in group A at 6, 8, and 12 h postoperatively. In group B, serum lidocaine levels reached its peak (31.4 ± 3.01 ng/mL) at 12 h and were negatively and strongly correlated with VAS at 12, 18, and 24 hours (r = −0.736 and P < 0.001). All postoperative adverse effects were minimal and mild.Conclusion: After KA, LP5 supplementation to IA bupivacaine and dexmedetomidine decreased the postoperative pain and narcotic requirements safely.

Preemptive analgesia in hip arthroscopy: intra-articular bupivacaine does not improve pain control after preoperative peri-acetabular blockade.

Literature addressing postoperative pain management after hip arthroscopy is relatively scarce. This study aimed to assess if there was added analgesic benefit associated with postoperative intra-articular bupivacaine blockade for patients who received preoperative peri-acetabular blockade for hip arthroscopy procedures. 52 patients were included in this comparative cohort study. Group 1 consisted of 20 patients who received preoperative peri-acetabular blockade and postoperative intra-articular blockade. The control group (Group 2), consisted of 32 patients who received only preoperative peri-acetabular blockade. Postoperative pain was recorded via visual analogue scale (VAS) pain scores, analgesic consumption, and pain diaries for 2 weeks postoperatively. Postoperative VAS pain scores were significantly lower in the experimental group at the 30-minute recovery room assessment (VAS scores Group 1: 1.1; Group 2: 3.00, p = 0.034). Other than the 30-minute recovery room assessment, VAS pain scores, narcotic medication consumption, and non-narcotic analgesic consumption did not differ between the 2 groups at any time point in the study period. This study did not demonstrate significant clinical benefit for patients who receive postoperative intra-articular blockade in addition to preoperative peri-acetabular blockade with bupivacaine 0.5%. We recommend the use of preoperative peri-acetabular bupivacaine blockade without intra-articular blockade postoperatively for pain control in the setting of hip arthroscopy surgery.

Comparing the Effectiveness of Intra-Articular Injection of Bupivacaine, Dexmedetomidine Vs. 0.9% Saline on Pain Control after Arthroscopic Anterior Cruciate Ligament Reconstruction

Background: In different ways, drugs are administered to reduce postoperative analgesia after arthroscopic anterior cruciate ligament (ACL) reconstruction. The purpose of this study is to compare the dexmedetomidine (DEX) intra-articular injection with bupivacaine hydrochloride and sterile 0.9% saline administration following arthroscopic ACL reconstruction. Methods: Sixty cases who underwent ACL reconstruction were randomly divided into three groups. The first group received intra-articular DEX; the second group received intra-articular bupivacaine, and the final group received intra-articular 0.9% saline. Postoperative pain was measured by Visual Analogue Scale (VAS). Results: The mean VAS scores at 6 and 24 hours after surgery were lower in the bupivacaine group, compared to the other groups. Pain was more severe in the control group (0.9% saline), with higher VAS scores reported at 1, 6, and 24 hours after surgery. Conclusions: Bupivacaine has more significant effects than DEX in postoperative pain management after arthroscopic ACL reconstruction.

Comparison of Intra-Articular Bupivacaine and Neostigmine with Bupivacaine and Fentanyl for Post-Operative Analgesia in Arthroscopic Knee Surgeries

Background: The post-operative pain in knee arthroscopy procedures can be attributed to irritation of free nerve endings of synovial tissue, anterior fat pad, and joint capsule during surgical excision and resection1. In the recent years, new interest has focused on the cholinergic system that modulates pain perception and transmission. The present study is designed to compare the efficacy of intra- articular Bupivacaine and Neostigmine with Bupivacaine and Fentanyl for pain relief following arthroscopic surgeries.Subjects and Methods:Prospective, Interventional, Randomised study was conducted over 90 patients scheduled for elective arthroscopic knee surgery, who were randomly allocated into three equal groups of 30 patients each. Group I-Bupivacaine with Neostigmine, Group II-Bupivacaine with Fentanyl and Group III-Bupivacaine alone. The study drug combinations were administered Intra-articularly at the conclusion of surgery. Hemodynamic variables and Pain were observed immediately after completion of surgery (Baseline) and thereafter at fixed intervals. The duration of effective analgesia was measured from the “baseline” until the first use of rescue analgesic. The number of rescue analgesics given in 24 hours were also recorded. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 statistical Analysis Software.Results:Requirement for first analgesia was significantly earlier in Group III (146.00±71.66 minutes) as compared to Group II (236.00±111.34 minutes) and Group I (648.00±228.55 minutes). Majority of patients of Group I (90.0%) required rescue analgesia only once while in was twice in Group II (90.00%) and thrice in Group III (86.67%).Conclusion:Intra-articular administration of Neostigmine in combination with Bupivacaine provided a better post-operative analgesic effect with a lower incidence of side effects and lesser requirement of rescue analgesia.

Adjunct Analgesia Reduces Pain and Opioid Consumption After Hip Arthroscopy: A Systematic Review of Randomized Controlled Trials

Background: Patients who undergo hip arthroscopy inevitably experience pain postoperatively; however, the efficacy and safety of adjunct analgesia to prevent or reduce pain are not well-understood. Purpose: To perform a comprehensive qualitative synthesis of available randomized controlled trials evaluating the effect of adjunct analgesia on postoperative (1) pain, (2) opioid use, and (3) length of stay (LOS) in patients undergoing hip arthroscopy. Study Design: Systematic review. Methods: PubMed, OVID/MEDLINE, and Cochrane Controlled Register of Trials were queried for studies pertaining to analgesia interventions for patients undergoing hip arthroscopy. Two authors independently assessed article bias and eligibility. Data pertaining to changes in pain scores, additional analgesia requirements, length of hospital stay, and complications were extracted and qualitatively reported. Network meta-analyses were constructed to depict mean pain, opioid use, and LOS among the 3 analgesia categories (blocks, local infiltration analgesia, and celecoxib). Results: Fourteen level 1 studies were included; 12 (85.7%) reported pain reductions in the immediate and perioperative period after hip arthroscopy. Of the 7 studies that assessed an intervention (2 celecoxib, 1 fascia iliaca block, 1 lumbar plexus block, 1 femoral nerve block, 1 intra-articular bupivacaine, 1 extracapsular bupivacaine) versus placebo, more than half reported that patients who received an intervention consumed significantly fewer opioids postoperatively than patients who received placebo (lowest P value = .0006). Of the same 7 studies, 2 reported significantly shortened LOS with interventions, while 4 reported no statistically significant difference in LOS and 1 did not report LOS as an outcome. Conclusion: The majority of studies concerning adjunct analgesia for patients undergoing hip arthroscopy suggest benefits in pain reduction early in the postoperative period. There is mild evidence that adjunct analgesia reduces postoperative opioid use and currently inconclusive evidence that it reduces length of hospital stay. Furthermore, it appears that local infiltration analgesia may provide the greatest benefits in reductions in pain and opioid consumption. We recommend the use of adjunct analgesia in appropriately selected patients undergoing hip arthroscopy without contraindication who are at a high risk of severe postoperative pain.

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

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.

Improved rehabilitation and functional outcome with dedicated joint irrigation at the end of ACL reconstruction

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; ACL is most common ligament injured during sports. Postoperative pain and swelling is one of the major limiting factors for the rehabilitation of ACL reconstructed patients. Cryotherapy and intra-articular bupivacaine injection are few measures to reduce the pain. One of the main reason for pain is inflammatory mediators, by joint irrigation it reduce the inflammatory mediator that reduce pain and swelling.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We treated 33 patients of ACL injury with arthroscopic ACL reconstruction from July 2015 to April 2017. Postoperative pain and swellings were assed with VAS and suprapatellar fullness. VAS assessment done on 1&lt;sup&gt;st&lt;/sup&gt; day, 2&lt;sup&gt;nd&lt;/sup&gt; day and 12&lt;sup&gt;th&lt;/sup&gt; day and for swelling 2&lt;sup&gt;nd&lt;/sup&gt; day and 12&lt;sup&gt;th&lt;/sup&gt; day. We had used closed loop endobutton for femur and bioscrew for tibia. In twenty patients at the end of the surgery we used 2 liter saline for joint irrigation.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; As a result of wash of pro inflammatory mediators and debris, there were reduced inflammation which reduces pain and swelling. Patients who received irrigation had less VAS score and suprapatellar fullness than the other group. There was better knee flexion on 12&lt;sup&gt;th&lt;/sup&gt; day.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Adding up a dedicated joint irrigation at the end of surgery does not deviate from standard surgical protocol. No studies have stress upon joint irrigation. It reduce the pain and swelling by reducing inflammation which gives better result.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Intra-articular dexmedetomidine with bupivacaine versus bupivacaine alone for postoperative analgesia after knee arthroscopy

Background: Optimal relief of pain after knee arthroscopy is essential for early rehabilitation and mobilisation and to minimise postoperative morbidity. This study’s aim was to assess dexmedetomidine as an additive to intra-articular (IA) bupivacaine in terms of analgesic duration and postoperative rescue analgesic consumption following arthroscopic knee surgery.Methods: A total of 70 patients, ASA physical status I and II, undergoing knee arthroscopy under general anaesthesia were enrolled in this double-blinded randomised controlled study, after Pan African Clinical Trial Registry (PACTR201507001048242) approval was obtained. Patients were randomly assigned into two groups; the bupivacaine group (B) received IA 19 ml bupivacaine 0.5% + 1 ml normal saline, bupivacaine dexmedetomidine group (BD) received IA injection of 19 ml bupivacaine 0.5% + dexmedetomidine 100 μg (1 ml). Postoperative visual analogue pain score (VAS), duration of analgesia and postoperative analgesic requirement were assessed.Results: VAS scores at rest and on mobilisation were significantly lower in the BD group at 4 h, 6 h and 8 h postoperatively in comparison with group B (p < 0.05). VAS scores were comparable between studied groups during the first 2 h, and at 12 h and 24 h postoperatively. Duration of analgesia was significantly longer in group BD (458.9 ± 93.5 min) than in the B group (229.1 ± 83.7 min) (p < 0.05). Postoperative analgesic consumption was lowered in the BD group compared with the B group (p < 0.05).Conclusions: Adding dexmedetomidine to IA bupivacaine after knee arthroscopy prolongs analgesic duration and decreases postoperative analgesic requirement.Keywords: arthroscopy, dexmedetomidine, intra-articular, postoperative pain

Comparison of Efficacy of Intra-Articular Plain Bupivacaine and Bupivacaine with Adjuvants (Dexmedetomidine and Magnesium Sulfate) for Postoperative Analgesia in Arthroscopic Knee Surgeries: A Prospective, Randomized Controlled Trial.

Context:Intra-articular (IA) bupivacaine and adjuvants are used in multimodal analgesia for knee arthroscopy.Aims:To evaluate the efficacy of IA plain bupivacaine and bupivacaine with adjuvants (dexmedetomidine and magnesium [Mg] sulfate) for postoperative analgesia in knee arthroscopy.Settings and Design:This was a randomized controlled study in a tertiary care hospital.Methodology:Fifty-four patients were randomly allocated to receive 20 ml of study drug, 0.25% bupivacaine (Group B), 0.25% bupivacaine with 0.5 μg/kg of dexmedetomidine (Group D), and 0.25% bupivacaine with 10 mg/kg of Mg sulfate (Group M). Duration of analgesia, visual analog score for pain at rest (VAS-R) and movement (VAS-M), and number of times rescue analgesics were given in the first 24 h of postoperative period were assessed. Vital parameters and any side effects of the drugs were also noted at immediate (0, 5, 10, 15, and 30 min, 1 h) and late postoperative period (2, 4, 6, 12 and 24 h).Results:Duration of analgesia was prolonged in bupivacaine-dexmedetomidine and bupivacaine-Mg sulphate groups as compared to bupivacaine alone (5.97 ± 1.76 h, 13.44 ± 7.87 h, and 14.61 ± 8.83 h in Groups B, D, and M, respectively; P = 0.001). The VAS-R and VAS-M were less with Group D and Group M compared to Group B (P = 0.002 in VAS-R and P = 0.004 in VAS-M). The number of times rescue analgesic used was more in the Group B (2.06 ± 0.8, 0.94 ± 0.8, and 0.89 ± 0.9 in Groups B, D, and M, respectively; P < 0.001). The hemodynamic parameters were comparable and no side effects were noted among the three groups.Conclusion:IA bupivacaine with adjuvants prolongs duration and improves quality of postoperative analgesia as compared to bupivacaine alone.

Periarticular Liposomal Bupivacaine Injection Versus Intra-Articular Bupivacaine Infusion Catheter for Analgesia After Total Knee Arthroplasty: A Double-Blinded, Randomized Controlled Trial.

Intra-articular bupivacaine hydrochloride (HCl) infusion catheters and periarticular injections of liposomal bupivacaine are often used as postoperative local anesthetics. The purpose of this study was to compare the efficacies of these local anesthetics following total knee arthroplasty. This study was a superiority trial with a randomized, controlled, double-blinded design. Patients were randomly assigned to either delivery of bupivacaine HCl by the ON-Q* Pain Relief System pump (n = 96) or by an injection of Exparel (liposomal bupivacaine) (n = 104). The primary outcome of this study was cumulative narcotic consumption on postoperative days 0 through 3. Narcotic consumption data were collected retrospectively from in-hospital records while patients were in the hospital. Following discharge, narcotic consumption data were gathered from patient surveys, as were secondary outcomes measures. We did not identify greater narcotic use in the ON-Q* group compared with the Exparel group (p = 0.641). The mean difference between the groups was 0.5 morphine equivalent (95% confidence interval [CI] = -1.7 to +2.8), with the ON-Q* group consuming an average 10.4 morphine equivalents (95% CI = 8.7 to 12.0) compared with 10.9 (95% CI = 9.3 to 12.5) in the Exparel group. There were no significant differences between groups with regard to any of the secondary measures of pain with the exception of pain while walking and pain with physical therapy (p = 0.019 and p = 0.010, respectively), both of which showed an approximately 1-point difference in favor of the ON-Q* group on a visual analog scale (VAS). There were also no differences in the postoperative side effects, including nausea, constipation, or vomiting, or in the rates of study-related complications, patient satisfaction, or length of hospital stay. Exparel did not have superior efficacy compared with the ON-Q* Pain Relief System as reflected by narcotic consumption, our primary outcome. There were small significant differences, in favor of the ON-Q* group, in 2 secondary measures of pain during activity, but these approximately 1-point VAS differences are unlikely to be clinically relevant. The choice of a local anesthetic modality should be based on a combination of safety, convenience, and cost considerations. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.