Abstract
Purpose: To test the efficacy of a combination of selective pre- and post-surgical local anesthetic infiltrations of the knee, compared with standard intra-articular injection at the end of surgery alone, to reduce postoperative opioid requirements following arthroscopic cruciate ligament reconstruction (ACLR).
Methods: In a double-blind, randomized, controlled trial, we studied 23 patients (ASA I or II) scheduled for elective ACLR under general anesthesia. The treatment group (n=12) received infiltrations with bupivacaine 0.25% with 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, and 10 ml intra-articularly) and postsurgically (5 ml at the medial tibial incision 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 knee (25 ml of bupivacaine 0.25% with epinephrine 1:200 000) at the completion of surgery.
Results: Postoperative opioid requirements were lower in the treatment group (5.8±2.9 mg morphine equivalent) than in the control group (13.7±5.8 mg;P=0.008). Treatment patients were ready for discharge approximately 30 min earlier than control patients (P=0.046). There were no adverse events in the treatment group. In the control group, 2/11 patients vomited and a third experienced transient postoperative diaphoresis, dizziness and pallor.
Conclusion: We conclude that a combination of selective pre- and post-surgical would infiltration with bupivacaine 0.25% provides superior analgesia compared with a standard post-surgical intra-articular injection alone.
Résumé
Objectif: Tester l’efficacité d’une combinaison d’infiltrations sélectives du genou, préopératoires et postopératoires, avec un a nesthésique local, comparée à l’injection intra-articulaire régulière de fin d’intervention seulement, dans le but de réduire les besoins postopératoires d’opioïdes à la suite de la reconstruction arthroscopique du ligament croisé (RALC).
Méthode: L’étude randomisée, contrôlée et à double insu a porté sur 23 patients (ASA I ou II) pour qui une RALC avait été prévue sous anesthésie générale. Les patients étudiés (n=12) ont reçu des infiltrations préchirurgicales de bupivacaïne à 0,25 % avec de l’épinéphrine à 1:200 000 (10 ml via le portail, 10 ml au site d’incision tibial médian, 10 ml dans l’incision fémorale latérale et 10 ml intra-articulaire) et postchirurgicales (5 ml dans l’incision tibiale médiane et 10 ml dans l’incision fémorale latérale). Les patients témoins (n=11) ont reçu des infiltrations de solution salée à 0,9 %, administrées de la même manière. Tous les patients ont reçu une instillation anesthésique standard locale dans l’articulation du genou (25 ml de bupivacaïne à 0,25 % avec de l’épinéphrine à 1:200 000) à la fin de l’opération.
Résultats: Les patients testés ont demandé moins d’opioïdes postopératoires (5,8±2,9 mg d’équivalent de morphine) que les patients témoins (13,7±5,8 mg;P=0,008). Ils ont pu recveoir leur congé 30 min plus tôt que les patients témoins (P=0,046). On n’a pas noté d’effets indésirables chez les patients testés. Parmi les patients témoins, 2/11 ont eu des vomissements et un tiers a présenté une diaphorèse postopératoire transitoire, des étourdissements et de la pâleur.
Conclusion: Une combinaison d’infiltrations préchirurgicales et postchirurgicales du site d’incision avec de la bupivacaïne à 0,25 % fournit une analgésie supérieure à la seule injection intra-articulaire postchirurgicale standard.
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Butterfield, N.N., Schwarz, S.K.W., Ries, C.R. et al. Combined pre- and post-surgical bupivacaine would infiltrations decrease opioid requirements after knee ligament reconstruction. Can J Anesth 48, 245–250 (2001). https://doi.org/10.1007/BF03019753
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DOI: https://doi.org/10.1007/BF03019753