LOCAL AND INTRAARTICULAR INFILTRATION OF BUPIVACAINE BEFORE SURGERY -EFFECT ON POSTOPERATIVE PAIN AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

In a double-blind, randomized trial, 40 patients undergoing open anter ior cruciate ligament (ACL) reconstruction using a bone-patellar tendo n-bone autograft were randomly allocated to two groups: group A (n = 2 0) received an intra-articular instillation of 20 mt bupivacaine (0.25 %) and a local infiltration of 20 mt bupivacaine (0.5%) 15 minutes bef ore surgery. Group B (n = 20) received an injection of saline solution in the same manner. Patient-controlled on-demand analgesia (PCA) with intravenous piritramid was used for postoperative pain control. A sig nificant decrease in pain scores on a visual analog scale (VAS scale, 0 to 10) was found in the bupivacaine group (group A) at bedrest on th e day of surgery only (pain score, 5.5 v 7.3 (scale, 0 to 10), P < .05 ). At all other times, no significant differences were found. The over all supplemental opioid requirements were not different between the st udy groups (63.9 v 62.6 mg piritramid/72 hours). A long-lasting, clini cally relevant, pain-reducing effect with infiltration of bupivacaine before surgery could not be shown with this study.