Intraarticular levobupivacaine or bupivacaine administration decreases pain scores and provides a better recovery after total knee arthroplasty

• Published in: Journal of anesthesia 2010-10, Vol.24 (5), p.694-699
• Main Authors: Kazak Bengisun, Zuleyha, Aysu Salviz, E., Darcin, Kamil, Suer, Hikmet, Ates, Yesim
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Analgesia, Patient-Controlled; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Anesthesia; Anesthesiology; Anesthetics; Anesthetics, Local - administration & dosage; Anesthetics, Local - therapeutic use; Area Under Curve; Arthroplasty, Replacement, Knee; Bupivacaine - administration & dosage; Bupivacaine - analogs & derivatives; Bupivacaine - therapeutic use; Care and treatment; Critical Care Medicine; Double-Blind Method; Emergency Medicine; Epinephrine; Female; Humans; Injections, Intra-Articular; Intensive; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Pain; Pain Measurement - drug effects; Pain Medicine; Pain, Postoperative - drug therapy; Patient Satisfaction; Postoperative Nausea and Vomiting - epidemiology; Prospective Studies; Sample Size; Tramadol; Tramadol - administration & dosage; Tramadol - therapeutic use; Treatment Outcome; Young Adult
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-010-0970-x

Purpose The aim of this prospective randomized blinded controlled study was to compare the efficacy of the two local anesthetics, intraarticular bupivacaine and levobupivacaine administration, versus control for postoperative pain control and functional recovery. Length of hospital stay, opioid consumption, and the side effects of opioids were also evaluated. Methods Sixty patients of American Society of Anesthesiologists class I–III undergoing elective knee arthroplasty under spinal anesthesia were randomized into three groups. Groups B ( n  = 20) and L ( n  = 20) both received 150 ml solution intraarticularly, containing 200 mg bupivacaine or 200 mg levobupivacaine combined with 0.5 mg epinephrine, respectively, at the end of the surgery. Group C ( n  = 20) received 150 ml saline intraarticularly. Postoperatively, all groups received injections through the intraarticular catheters in quantities of 120 mg (levobupivacaine for group L, bupivacaine for group B) and 0.5 mg epinephrine whereas group C received a saline bolus at 10 and 22 h. Patients were given tramadol by intravenous patient-controlled analgesia (PCA), and sodium diclofenac 75 mg intramuscularly was used for rescue analgesic medication. Visual analogue score (VAS) for pain at rest and during mobilization (which was defined as flexion exercise supported by physiotherapist in postoperative first 8 h and afterward a 3-m walk with walker), consumption of tramadol, side effects, and patient satisfaction were recorded until the 48th hour postoperatively. Results Area under the curve values for VAS were lower in groups B and L compared to the control, both at rest and during mobilization (first 48 h) ( P  = 0.032 and P  = 0.029, respectively). Tramadol consumption was lower ( P