POSTOPERATIVE ANALGESIA FOR OUTPATIENT ARTHROSCOPIC KNEE SURGERY WITHINTRAARTICULAR BUPIVACAINE AND KETOROLAC

Intraarticular (IA) local anesthetics are often used for the managemen t and prevention of pain after arthroscopic knee surgery. Systemic ket orolac is also useful in the management-of-these patients. Ketorolac, a nonsteroidal antiinflammatory drug (NSAID), alters the sensitivity o f peripheral nociceptors by reducing the local concentration of alloge nic chemicals which are activated by peripheral tissue injury. It is i nteresting to speculate that placing a NSAID at the site of injury mig ht result in more profound pain relief. However, IA ketorolac has not been evaluated in arthroscopic patients. This study thus was designed to determine which regimen would result in the most effective analgesi c benefit. The four groups evaluated received ketorolac (either via th e parenteral or IA route) or saline placebo with or without IA bupivac aine, as follows: Group 1 received IA bupivacaine; Group 2, intravenou s ketorolac and IA bupivacaine; Group 3, IA bupivacaine with ketorolac ; and Group 4, IA ketorolac. The results of this study revealed a sign ificant difference in analgesia from the IA administration of ketorola c. The group who received a combination of IA bupivacaine and IA ketor olac had decreased postoperative pain, a decreased need for postoperat ive analgesics, and an increased analgesic duration. We conclude that the use of IA ketorolac improved comfort in patients undergoing knee a rthroscopy.