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Bupivacaine injections effective for post-arthroscopy ankle pain, study shows
Intra-articular bupivacaine showed the most benefit within 8 hours postop; using additional analgesics, such as opioids, may enhance the effect.
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Intra-articular bupivacaine may be an effective alternative to oral opioids and other anti-inflammatory drugs for managing postoperative pain following ankle arthroscopy, the results of a prospective study suggest.
Fiona Middleton, MBBS, FRCS(Tr & Orth), and colleagues conducted the randomized, blinded study of 35 ankle arthroscopy patients. The researchers assigned 17 patients to receive an intra-articular injection containing 20 mL of 0.5% bupivacaine and 18 patients to receive 20 mL of normal saline solution. All injections were administered upon completion of surgery.
Both groups were similar in age, gender and duration of tourniquet application. In all cases, surgeons used a standardized arthroscopy technique, and a similar number of patients in both groups underwent arthroscopic debridement.
Postoperatively, upon request while in the recovery room, patients were allowed supplementary analgesia consisting of two tablets of co-codamol 30/500, up to a maximum of 250 mg IV tramadol and 1 mg to 10 mg IV morphine. Patients were also given a 10-day supply of diclofenac for regular use and co-codamol 30/500 to use as needed.
The researchers found that bupivacaine-treated patients had significantly lower Visual Analog Scale (VAS) scores for pain up to 2 hours postop (P=.01). They also had lower mean VAS pain scores on the first day postop, although the difference was not statistically significant, the authors noted.
In addition, bupivacaine-treated patients used significantly less IV tramadol during immediate postop recovery, averaging 44.1 mg compared to 91.7 mg for saline-treated patients (P=.009). Four patients (24%) in the bupivacaine group and 15 patients (83%) in the saline group required tramadol during immediate postop recovery. And additional four saline-treated patients (22%) also required morphine, according to the study.
Both groups used similar amounts of co-codamol following discharge. No patients experienced any side effects of complications associated with bupivacaine use, the authors reported.
"The main benefit of intra-articular bupivacaine was in the first 8 hours, and in view of this the addition of other adjuvants, such as [an] opioid or clonidine, may provide longer-lasting analgesia," the authors wrote, noting further studies are needed to determine the benefit of adjuvant drugs.
The results are published in the British edition of the Journal of Bone and Joint Surgery.
For more information:
- Middleton F, Coakes J, Umarji S, et al. The efficacy of intra-articular bupivacaine for relief of pain following arthroscopy of the ankle. J Bone Joint Surg Br. 2006;88-B:1603-1605.