The effects of intra-articular levobupivacain versus levobupivacain plus magnesium sulfate on postoperative analgesia in patients undergoing arthroscopic meniscectomy: A prospective randomized controlled study

Nurcan Kızılcık, Turhan Özler, Ferdi Menda, Çağatay Uluçay, Özge Köner, Faik Altıntaş, Nurcan Kızılcık, Turhan Özler, Ferdi Menda, Çağatay Uluçay, Özge Köner, Faik Altıntaş

Abstract

Objective: The aim of this study was to compared the effectiveness of intraarticular levobupivacain with levobupivacain and magnesium sulfate.

Methods: In this prospective randomized double blinded study, 96 patients (67 male, 29 female; age range: 18-65 years) with ASA (American Society of Anesthesiologist) score I and II, who had undergone arthroscopic meniscectomy operation, were divided to 3 groups that had postoperative analgesia with intra-articular saline injection (control group), levobupivacain injection (L group) or levobupivacain and magnesium sulfate injection (LM group). Patients were compared with postoperative VAS (Visual Analog Score) score during rest and activity, opioid analgesic need, non-opioid analgesic need and other medication needs.

Results: Postoperative VAS scores during rest and activation at early postoperative period were significantly lower at LM group when compared with L group and lower than control group at all time periods. Opioid analgesic need, non-opioid analgesic need and other medication needs for non-pain symptoms were lower at LM group when compared with L and control groups at all time periods.

Conclusion: Intraarticular magnesium sulfate plus Levobupivacain injection is a safe and effective method for post operative pain management after arthroscopic meniscectomy.

Keywords: Arthroscopic menisectomy; Arthroscopic menisectomy LEVEL OF EVIDENCE: Level I Therapeutic study.; Chondrocyte apoptosis; Intra-articular injection; Levobupivacain; Magnesium sulfate; Pain management; Postoperative analgesia.

Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Figures

Fig. 1
Fig. 1
Flow chart.
Graph 1
Graph 1
Pain during mobilization.
Graph 2
Graph 2
Pain scale.
Graph 3
Graph 3
Tramadol hydrochloride use.

References

    1. Elvir-Lazo O.L., White P.F. The role of multimodal analgesia in pain management after ambulatory surgery. Curr Opin Anaesthesiol. 2010;23:697–703.
    1. Benyamin R., Trescot A.M., Datta S. Opioid complications and side effects. Pain Physician. 2008;11:105–120.
    1. Ayoglu H., Altunkaya H., Bayar A., Turan I.O. The effect of intraarticular combinations of tramadol and ropivacaine with ketamine on postoperative pain after arthroscopic meniscectomy. Arch Orthop Trauma Surg. 2010;130:307–312.
    1. Lo I.K., Sciore P., Chung M., Liang S. Local anesthetics induce chondrocyte death in bovine articular cartilage disks in a dose- and duration-dependent manner. Arthroscopy. 2009;25:707–715.
    1. Gungor I., Yilmaz A., Ozturk A.M., Ergun M.A. Bupivacaine and levobupivacaine induce apoptosis in rat chondrocyte cell cultures at ultra-low doses. Eur J Orthop Surg Traumatol. 2014;24:291–295.
    1. Hoofwijk D.M., Fiddelers A.A., Emans P.J. Prevalence and predictive factors of chronic postsurgical pain and global surgical recovery 1 Year after outpatient knee arthroscopy: a prospective cohort study. Med Baltim. 2015;94:e2017.
    1. Gristwood R.W. Cardiac and CNS toxicity of levobupivacaine: strengths of evidence for advantage over bupivacaine. Drug Saf. 2002;25:153–163.
    1. Lykoudi I., Kottis G., Nikolaou V.S., Setaki P., Fassoulaki A., Efstathopoulos N. Intra-articular morphine enhances analgesic efficacy of ropivacaine for knee arthroscopy in ambulatory patients. Orthopedics. 2011;34:91–102.
    1. Koltka K., Koknel-Talu G., Asik M., Ozyalcin S. Comparison of efficacy of intra-articular application of magnesium, levobupivacaine and lornoxicam with placebo in arthroscopic surgery. Knee Surg Sports Traumatol Arthrosc. 2011;19:1884–1889.
    1. Mitra S., Kaushal H., Gupta R.K. Evaluation of analgesic efficacy of intra-articular bupivacaine, bupivacaine plus fentanyl, and bupivacaine plus tramadol after arthroscopic knee surgery. Arthroscopy. 2011;27:1637–1643.
    1. Chen Y., Zhang Y., Zhu Y.L., Fu P.L. Efficacy and safety of an intra-operative intra-articular magnesium/ropivacaine injection for pain control following total knee arthroplasty. J Int Med Res. 2012;40:2032–2040.
    1. Campo M.M., Kerkhoffs G.M., Sierevelt I.N., Weeseman R.R. A randomised controlled trial for the effectiveness of intra-articular Ropivacaine and Bupivacaine on pain after knee arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2012;20:239–244.
    1. Al-Metwalli R.R., Mowafi H.A., Ismail S.A., Siddiqui A.K. Effect of intra-articular dexmedetomidine on postoperative analgesia after arthroscopic knee surgery. Br J Anaesth. 2008;101:395–399.
    1. Batra Y.K., Mahajan R., Kumar S., Rajeev S. A dose-ranging study of intraarticular midazolam for pain relief after knee arthroscopy. Anesth Analg. 2008;107:669–672.
    1. Eroglu A., Saracoglu S., Erturk E., Kosucu M. A comparison of intraarticular morphine and bupivacaine for pain control and outpatient status after an arthroscopic knee surgery under a low dose of spinal anaesthesia. Knee Surg Sports Traumatol Arthrosc. 2010;18:1487–1495.
    1. Ersan Ö., Akkaya T., Arık E., Ateş Y. Intra-articular levobupivacaine, lornoxicam and morphine analgesia after knee arthroscopy: a randomized, controlled trial. Acta Orthop Traumatol Turc. 2012;46(6):411–415.
    1. Sayın P., Dobrucalı H., Türk H.Ş., Totoz T., Işıl C.T., Hancı A. Effects of intra-articular levobupivacain, fentanyl-levobupivacaine and tramadol-levobupivacaine for postoperative pain in arthroscopic knee surgery. Acta Orthop Traumatol Turc. 2015;49(3):267–273.
    1. Sedighinejad A., Haghighi M., Naderi Nabi B., Rahimzadeh P. Magnesium sulfate and sufentanil for patient-controlled analgesia in orthopedic surgery. Anesth Pain Med. 2014;4:1133–1134.
    1. Bondok R.S., Abd El-Hady A.M. Intra-articular magnesium is effective for postoperative analgesia in arthroscopic knee surgery. Br J Anaesth. 2006;97:389–392.
    1. Iwatsu O., Ushida T., Tani T., Lawand N.B. Peripheral administration of magnesium sulfate and ketamine hydrochloride produces hypethesia to mechanical stimuli in humans. J Health Sci. 2002;48:69–72.
    1. Cairns B.E., Svensson P., Wang K. Activation of peripheral NMDA receptors contributes to human pain and rat afferent discharges evoked by injection of glutamate into the masseter muscle. J Neurophysiol. 2003;90:2098–2105.
    1. Lawand N.B., Willis W.D., Westlund K.N. Excitatory amino acid receptor involvement in peripheral nociceptive transmission in rats. Eur J Pharmacol. 1997;324:169–177.
    1. Farouk S., Aly A. A comparison of intra-articular magnesium and/or morphine with bupivacaine for postoperative analgesia after arthroscopic knee surgery. J Anesth. 2009;23:508–512.
    1. Zeidan A., Kassem R., Nahleh N., Maaliki H. Intraarticular tramadol-bupivacaine combination prolongs the duration of postoperative analgesia after outpatient arthroscopic knee surgery. Anesth Analg. 2008;107:292–299.
    1. Ravnihar K., Barlič A., Drobnič M. Effect of intra-articular local anesthesia on articular cartilage in the knee. Arthroscopy. 2014;30:607–612.
    1. Breu A., Scheidhammer I., Kujat R., Graf B. Local anesthetic cytotoxicity on human mesenchymal stem cells during chondrogenic differentiation. Knee Surg Sports Traumatol Arthrosc. 2015;23:937–945.
    1. Grishko V., Xu M., Wilson G., Pearsall A.W. Apoptosis and mitochondrial dysfunction in human chondrocytes following exposure to lidocaine, bupivacaine, and ropivacaine. J Bone Jt Surg Am. 2010;92:609–618.
    1. Chu C.R., Izzo N.J., Coyle C.H. The in vitro effects of bupivacaine on articular chondrocytes. J Bone Jt Surg Br. 2008;90:814–820.
    1. Chu C.R., Coyle C.H., Chu C.T., Szczodry M. In vivo effects of single intra-articular injection of 0.5% bupivacaine on articular cartilage. J Bone Jt Surg Am. 2010;92:599–608.
    1. Jacobson E., Assareh H., Cannerfelt R., Anderson R.E. The postoperative analgesic effects of intra-articular levobupivacaine in elective day-case arthroscopy of the knee: a prospective, randomized, double-blind clinical study. Knee Surg Sports Traumatol Arthrosc. 2006;14:120–124.
    1. Baker J.F., Solayar G.N., Byrne D.P., Moran R. Analgesic control and functional outcome after knee arthroscopy: results of a randomized double-blinded trial comparing a hyaluronic acid supplement with bupivacaine. Clin J Sport Med. 2012;22:109–115.
    1. Baker J.F., Walsh P.M., Byrne D.P., Mulhall K.J. In vitro assessment of human chondrocyte viability after treatment with local anaesthetic, magnesium sulfate or normal saline. Knee Surg Sports Traumatol Arthrosc. 2011;19:1043–1046.
    1. Hagandora C.K., Tudares M.A., Almarza A.J. The effect of magnesium ion concentration on the fibrocartilage regeneration potential of goat costal chondrocytes. Ann Biomed Eng. 2012;40:688–696.
    1. Elsharnouby N.M., Eid H.E., Abou Elezz N.F., Moharram A.N. Intra-articular injection of magnesium sulfate and/or bupivacaine for postoperative analgesia after arthroscopic knee surgery. Anesth Analg. 2008;106:1548–1552.
    1. Lee C.H., Wen Z.H., Chang Y.C., Huang S.Y. Intra-articular magnesium sulfate (MgSO4) reduces experimental osteoarthritis and nociception: association with attenuation of N-methyl-D-aspartate (NMDA) receptor subunit 1 phosphorylation and apoptosis in rat chondrocytes. Osteoarthr Cartil. 2009;17:1485–1493.
    1. Sugimoto J., Romani A.M., Valentin-Torres A.M., Luciano A.A. Magnesium decreases inflammatory cytokine production: a novel innate immunomodulatory mechanism. J Immunol. 2012;188:6338–6346.
    1. Lin C.Y., Tsai P.S., Hung Y.C., Huang C.J. L-type calcium channels are involved in mediating the anti-inflammatory effects of magnesium sulfate. Br J Anaesth. 2010;104:44–51.

Source: PubMed

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