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Canadian Journal of Anesthesia

, Volume 48, Issue 3, pp 245–250 | Cite as

Combined pre- and post-surgical bupivacaine would infiltrations decrease opioid requirements after knee ligament reconstruction

  • Noam N. Butterfield
  • Stephan K. W. Schwarz
  • Craig R. Ries
  • Luigi G. Franciosi
  • Brian Day
  • Bernard A. MacLeod
General Anesthesia

Abstract

Purpose: To test the efficacy of a combination of selective pre- and post-surgical local anesthetic infiltrations of the knee, compared with standard intra-articular injection at the end of surgery alone, to reduce postoperative opioid requirements following arthroscopic cruciate ligament reconstruction (ACLR).

Methods: In a double-blind, randomized, controlled trial, we studied 23 patients (ASA I or II) scheduled for elective ACLR under general anesthesia. The treatment group (n=12) received infiltrations with bupivacaine 0.25% with epinephrine 1:200 000 presurgically (10 ml into the portals, 10 ml at the medial tibial incision site, 10 ml at the lateral femoral incision site, and 10 ml intra-articularly) and postsurgically (5 ml at the medial tibial incision and 10 ml at the lateral femoral incision). The control group (n=11) received infiltrations with saline 0.9% in the same manner. All patients received a standard intra-articular local anesthetic instillation of the knee (25 ml of bupivacaine 0.25% with epinephrine 1:200 000) at the completion of surgery.

Results: Postoperative opioid requirements were lower in the treatment group (5.8±2.9 mg morphine equivalent) than in the control group (13.7±5.8 mg;P=0.008). Treatment patients were ready for discharge approximately 30 min earlier than control patients (P=0.046). There were no adverse events in the treatment group. In the control group, 2/11 patients vomited and a third experienced transient postoperative diaphoresis, dizziness and pallor.

Conclusion: We conclude that a combination of selective pre- and post-surgical would infiltration with bupivacaine 0.25% provides superior analgesia compared with a standard post-surgical intra-articular injection alone.

Keywords

Morphine Bupivacaine Anterior Cruciate Ligament Reconstruction Knee Arthroscopy Local Anesthet 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif: Tester l’efficacité d’une combinaison d’infiltrations sélectives du genou, préopératoires et postopératoires, avec un a nesthésique local, comparée à l’injection intra-articulaire régulière de fin d’intervention seulement, dans le but de réduire les besoins postopératoires d’opioïdes à la suite de la reconstruction arthroscopique du ligament croisé (RALC).

Méthode: L’étude randomisée, contrôlée et à double insu a porté sur 23 patients (ASA I ou II) pour qui une RALC avait été prévue sous anesthésie générale. Les patients étudiés (n=12) ont reçu des infiltrations préchirurgicales de bupivacaïne à 0,25 % avec de l’épinéphrine à 1:200 000 (10 ml via le portail, 10 ml au site d’incision tibial médian, 10 ml dans l’incision fémorale latérale et 10 ml intra-articulaire) et postchirurgicales (5 ml dans l’incision tibiale médiane et 10 ml dans l’incision fémorale latérale). Les patients témoins (n=11) ont reçu des infiltrations de solution salée à 0,9 %, administrées de la même manière. Tous les patients ont reçu une instillation anesthésique standard locale dans l’articulation du genou (25 ml de bupivacaïne à 0,25 % avec de l’épinéphrine à 1:200 000) à la fin de l’opération.

Résultats: Les patients testés ont demandé moins d’opioïdes postopératoires (5,8±2,9 mg d’équivalent de morphine) que les patients témoins (13,7±5,8 mg;P=0,008). Ils ont pu recveoir leur congé 30 min plus tôt que les patients témoins (P=0,046). On n’a pas noté d’effets indésirables chez les patients testés. Parmi les patients témoins, 2/11 ont eu des vomissements et un tiers a présenté une diaphorèse postopératoire transitoire, des étourdissements et de la pâleur.

Conclusion: Une combinaison d’infiltrations préchirurgicales et postchirurgicales du site d’incision avec de la bupivacaïne à 0,25 % fournit une analgésie supérieure à la seule injection intra-articulaire postchirurgicale standard.

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Copyright information

© Canadian Anesthesiologists 2001

Authors and Affiliations

  • Noam N. Butterfield
    • 3
  • Stephan K. W. Schwarz
    • 3
    • 1
  • Craig R. Ries
    • 3
    • 1
  • Luigi G. Franciosi
    • 3
  • Brian Day
    • 2
  • Bernard A. MacLeod
    • 3
    • 1
  1. 1.From the Clinical Pharmacology Research Organization (CPRO), Department of AnesthesiaThe University of British ColumbiaVancouverCanada
  2. 2.Department of OrthopaedicsThe University of British ColumbiaVancouverCanada
  3. 3.Clinical Pharmacology Research Organization, Department of Pharmacology & TherapeuticsThe University of British ColumbiaVancouverCanada

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