Combined pre- and post-surgical bupivacaine wound infiltrations decrease opioid requirements after knee ligament reconstruction

• Published in: Canadian journal of anesthesia 2001-03, Vol.48 (3), p.245-250
• Main Authors: BUTTERFIELD, Noam N, SCHWARZ, Stephan K. W, RIES, Craig R, FRANCIOSI, Luigi G, DAY, Brian, MACLEOD, Bernard A
• Format: Article
• Language: English
• Subjects: Adult; Analgesics, Opioid - adverse effects; Analgesics, Opioid - therapeutic use; Anesthesia; Anesthesia, General; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local - administration & dosage; Anesthetics, Local - adverse effects; Anesthetics, Local - therapeutic use; Anterior Cruciate Ligament - surgery; Biological and medical sciences; Bupivacaine - administration & dosage; Bupivacaine - adverse effects; Bupivacaine - therapeutic use; Double-Blind Method; Female; Humans; Local anesthesia. Pain (treatment); Male; Medical sciences; Morphine - administration & dosage; Morphine - therapeutic use; Pain Measurement; Pain, Postoperative - drug therapy; Pain, Postoperative - prevention & control; Patient Satisfaction; Postoperative Nausea and Vomiting - epidemiology; Surveys and Questionnaires
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/BF03019753

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). 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. 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. We conclude that a combination of selective pre- and post-surgical wound infiltration with bupivacaine 0.25% provides superior analgesia compared with a standard post-surgical intra-articular injection alone.