Comparison of intraarticular bupivacaine and levobupivacaine with morphine and epinephrine for knee arthroscopy

Abstract

Objective: To compare the efficacy of intraarticularly injected bupivacaine with levobupivacaine when administered in combination with morphine and adrenaline for post-operative analgesia and functional recovery after knee surgery.

Materials and methods: Sixty American Society of Anesthesiologists physical status I-II patients were randomized into three groups: Group B was administered 30 mL isobaric 0.5% bupivacaine, 2 mg morphine and 100 μg adrenaline, Group L was administered 30 mL 0.5% levobupivacaine, 2 mg morphine and 100 μg adrenaline, and Group C was administered 30 mL 0.9% NaCl solution into the knee joint by the surgeon at the end of surgery. The morphine usage and visual analog pain scores were recorded regularly afterwards. We also recorded the time that elapsed before each patients' first mobilization, positive response to straight leg raising, tolerance to 30-50° knee flexion, recovery of quadriceps reflexes and discharge from the hospital. We also recorded patient and surgeon satisfaction.

Results: The pain scale values were lower in Groups B and L than in Group C at 2, 4, 6, 8, 12 and 24 hours post-operatively (all p<0.001). In Groups B and L, the time for first analgesic request was longer (p<0.01), the morphine consumption was lower (p<0.001), and the duration of morphine usage was shorter (p<0.001). The times to positive response to straight leg raising, tolerance to 30-50° knee flexion and the first mobilization were shorter in Groups B and L (p<0.001 for all).

Conclusion: After arthroscopic knee surgery, intraarticular levobupivacaine combined with morphine and adrenaline decreases analgesic requirements, shortens the postoperative duration of analgesic use and hastens mobilization as effectively as bupivacaine.

Keywords: Arthroscopic surgery; bupivacaine; intraarticular injection; levobupivacaine; postoperative pain.

Figures

Figure 1.

Postoperative changes in heart rate (HR[bpm]). *p<0.05; Group C vs Groups B and L.

Figure 2.

Postoperative changes in mean arterial pressure (MAP[mmHg]).

Figure 3.

Cumulative intravenous morphine consumption delivered by patient-controlled analgesia (PCA) devices during a 24-hour study period. *p<0.05 or **p<0.001; Group C vs Groups B and L.