Nn. Butterfield et al., Combined pre- and post-surgical bupivacaine wound infiltrations decrease opioid requirements after knee ligament reconstruction, CAN J ANAES, 48(3), 2001, pp. 245-250
Citations number
34
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Journal title
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE
Purpose: To test the efficacy of a combination of selective pre- and post-s
urgical local anesthetic infiltrations of the knee, compared with standard
intra-articular injection at the end of surgery alone, to reduce postoperat
ive opioid requirements following arthroscopic cruciate ligament reconstruc
tion (ACLR).
Methods: In a double-blind, randomized, controlled trial, we studied 23 pat
ients (ASA I or II) scheduled for elective ACLR under general anesthesia. T
he treatment group (n=12) received infiltrations with bupivacaine 0.25% wit
h 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, a
nd 10 ml intra-articularly) and postsurgically (5 ml at the medial tibial i
ncision 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 kn
ee (25 ml of bupivacaine 0.25% with epinephrine 1 :200 000) at the completi
on of surgery.
Results: Postoperative opioid requirements were lower in the treatment grou
p (5.8 +/- 2.9 mg morphine equivalent) than in the control group( 1 3.7 +/-
5.8 mg; P=0.008). Treatment patients were ready for discharge approx imate
ly 30 min earlier than control patients (P=0.046). There were no adverse ev
ents in the treatment group, In the control group, 2/11 patients vomited an
d a third experienced transient postoperative diaphoresis, dizziness and pa
llor.
Conclusion: We conclude that a combination of selective pre- and post-surgi
cal wound infiltration with bupivacaine 0.25% provides superior analgesia c
ompared with a standard post-surgical intra-articular injection alone.