INTRAARTICULAR GLUCOCORTICOID, BUPIVACAINE AND MORPHINE REDUCES PAIN,INFLAMMATORY RESPONSE AND CONVALESCENCE AFTER ARTHROSCOPIC MENISCECTOMY

Convalescence after arthroscopic meniscectomy is dependent on pain and the inflammatory response. The aim of the study was therefore to inve stigate the effect of intra-articular bupivacaine + morphine + methylp rednisolone versus bupivacaine + morphine or saline on postmeniscectom y pain, mobilisation and convalescence. In a double-blind randomized s tudy 60 patients undergoing arthroscopic meniscectomy were allocated t o intra-articular saline, intra-articular bupivacaine 150 mg + morphin e 4 mg or the same dose of bupivacaine + morphine + intra-articular me thylprednisolone 40 mg. All patients were instructed to resume normal activities immediately after operation. Pain during movement and walki ng, leg muscle force and joint effusion, use of crutches and duration of sick leave were assessed. Combined bupivacaine and morphine signifi cantly reduced pain, time of immobilisation and duration of convalesce nce. Addition of methylprednisolone further reduced pain, use of addit ional analgesics. joint swelling and convalescence, improved muscle fu nction and prevented the inflammatory response (acute phase protein) ( P < 0.05). A multimodal analgesic and anti-inflammatory treatment may enhance post-arthroscopic convalescence, which depends on the trauma i nduced inflammatory response and pain. (C) 1998 International Associat ion for the Study of Pain. Published by Elsevier Science B.V.