Document Detail


Evaluation of analgesic efficacy of intra-articular bupivacaine, bupivacaine plus fentanyl, and bupivacaine plus tramadol after arthroscopic knee surgery.
MedLine Citation:
PMID:  22047926     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To compare the efficacy of intra-articular (IA) bupivacaine, bupivacaine-fentanyl, and bupivacaine-tramadol for relief of postoperative pain after arthroscopic knee surgery.
METHODS: In a randomized double-blind design, 60 adult American Society of Anesthesiologists class I or class II patients undergoing elective arthroscopic knee surgery under general anesthesia were randomized to 3 groups: all received 30 mL of 0.25% bupivacaine, plus either 1 mL of normal saline solution (group I), 1 mL (50 μg) of fentanyl (group II), or 1 mL (50 mg) of tramadol (group III). Pain was assessed by use of a 100-mm visual analog scale (VAS) at 0, 1, 2, 4, 6, and 8 hours postoperatively. Intramuscular diclofenac sodium was used as rescue analgesic. Postoperative adverse effects were noted.
RESULTS: The mean VAS pain scores were the lowest for group II, intermediate for group III, and highest for group I. There was a significant main effect for group differences on pain scores (F = 41.138, P < .001). The main effect for the time factor was also significant (F = 6.097, P < .001). However, both group II and group III were comparable and both were superior to group I with regard to supplementary analgesia in terms of (1) number of patients receiving it, (2) total consumption during the study period, and (3) time to first supplementary analgesic requirement. The incidence of adverse event was comparable among the 3 groups.
CONCLUSIONS: On the primary outcome measure (VAS pain score), both bupivacaine with fentanyl and bupivacaine with tramadol were better than IA bupivacaine, and bupivacaine with fentanyl was better than that with tramadol. However, both the combinations were comparable to each other with regard to the secondary outcome measure (supplementary analgesic requirement). Thus IA bupivacaine-fentanyl appears to be the best combination for relief of postoperative pain in patients undergoing arthroscopic knee surgery, followed by IA bupivacaine-tramadol.
LEVEL OF EVIDENCE: Level I, randomized controlled trial.
Authors:
Sukanya Mitra; Harpreet Kaushal; Ravi K Gupta
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2011-11-01
Journal Detail:
Title:  Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association     Volume:  27     ISSN:  1526-3231     ISO Abbreviation:  Arthroscopy     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-05     Completed Date:  2012-06-07     Revised Date:  2012-08-23    
Medline Journal Info:
Nlm Unique ID:  8506498     Medline TA:  Arthroscopy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1637-43     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Anaesthesiology & Intensive Care, Government Medical College & Hospital, Chandigarh, India. drsmitra12@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Analgesia / methods*
Analgesics, Opioid / administration & dosage
Anesthetics, Local / administration & dosage
Arthroscopy*
Bupivacaine / administration & dosage*
Double-Blind Method
Drug Therapy, Combination
Female
Fentanyl / administration & dosage*
Follow-Up Studies
Humans
Injections, Intra-Articular
Knee Injuries / surgery*
Male
Pain Measurement
Pain, Postoperative / drug therapy*
Postoperative Care
Prospective Studies
Tramadol / administration & dosage*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Analgesics, Opioid; 0/Anesthetics, Local; 2180-92-9/Bupivacaine; 27203-92-5/Tramadol; 437-38-7/Fentanyl
Comments/Corrections
Comment In:
Arthroscopy. 2012 Jul;28(7):897-8; author reply 898-9   [PMID:  22738748 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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