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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 7/2014

01-07-2014 | Knee

Single-dose intra-articular bupivacaine after knee arthroscopic surgery: a meta-analysis of randomized placebo-controlled studies

Authors: Jie Wei, Hao-bin Yang, Jia-bi Qin, Fan-jing Kong, Tu-bao Yang

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 7/2014

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Abstract

Purpose

The purpose of this meta-analysis was to examine the efficacy and safety of single-dose intra-articular bupivacaine in the management of pain after knee arthroscopic surgery.

Method

The comprehensive literature search, using MEDLINE, the Cochrane Central Register of Controlled Trials, and Embase databases, was conducted to identify randomized controlled trials that used single-dose intra-articular bupivacaine for postoperative pain. The relative risk (RR), weighted mean difference (WMD), and their corresponding 95 % confidence intervals (CIs) were calculated using RevMan® statistical software.

Result

Twenty-three studies (n = 1287) were included (647 subjects in bupivacaine group and 640 subjects in the control group). Statistically significant differences were observed in the VAS values (WMD −1.1; 95 % CI −1.7 to −0.5), number of patients requiring supplementary analgesia (RR 0.83; 95 % CI 0.74–0.94), and time to first analgesic request (WMD 129.3; 95 % CI 15.4–243.1) among the bupivacaine group when compared to the control group. However, short-term side effects had no significant difference between these two groups (RR 0.73; 95 % CI 0.44–1.24).

Conclusions

On the basis of the currently available literature, single-dose intra-articular bupivacaine was shown to be significantly better than placebo at relieving pain after knee arthroscopic surgery. More high-quality randomized controlled trials with long follow-up are highly required for examining the safety of single-dose intra-articular bupivacaine. Besides, routine use of single-dose intra-articular bupivacaine is still an effective way for pain management after knee arthroscopic surgery.

Level of evidence

II.
Literature
1.
Aasbo V, Raeder JC, Grogaard B et al (1996) No additional analgesic effect of intra-articular morphine or bupivacaine compared with placebo after elective knee arthroscopy. Acta Anaesthesiol Scand 40:585–588PubMedCrossRef
2.
Alagol A, Calpur OU, Usar PS et al (2005) Intraarticular analgesia after arthroscopic knee surgery: comparison of neostigmine, clonidine, tenoxicam, morphine and bupivacaine. Knee Surg Sports Traumatol Arthrosc 13:658–663PubMedCrossRef
3.
Albright GA (1979) Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. J Anesth 51:285–287CrossRef
4.
Ates Y, Kinik H, Binnet MS et al (1994) Comparison of prilocaine and bupivacaine for post-arthroscopy analgesia: a placebo-controlled double-blind trial. Arthroscopy 10:108–109PubMedCrossRef
5.
Batra YK, Mahajan R, Bangalia SK et al (2005) Bupivacaine/ketamine is superior to intra-articular ketamine analgesia following arthroscopic knee surgery. Can J Anaesth 52:832–836PubMedCrossRef
6.
Begg B, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101PubMedCrossRef
7.
Bjornsson A, Gupta A, Vegfors M et al (1994) Intraarticular morphine for postoperative analgesia following knee arthroscopy. Reg Anesth 19:104–108
8.
Boden BP, Fassler S, Cooper S et al (1994) Analgesic effect of intraarticular morphine, bupivacaine, and morphine/bupivacaine after arthroscopic knee surgery. Arthroscopy 1:104–107CrossRef
9.
Calmet J, Esteve C, Boada S et al (2004) Analgesic effect of intra-articular ketorolac in knee arthroscopy: comparison of morphine and bupivacaine. Knee Surg Sports Traumatol Arthrosc 12:552–555PubMedCrossRef
10.
Campo MM, Kerkhoffs GM, Sierevelt IN et al (2012) A randomised controlled trial for the effectiveness of intra-articular Ropivacaine and Bupivacaine on pain after knee arthroscopy: the DUPRA (DUtch Pain Relief after Arthroscopy)-trial. Knee Surg Sports Traumatol Arthrosc 20:239–244PubMedCentralPubMedCrossRef
11.
Cepeda MS, Uribe C, Betancourt J et al (1997) Pain relief after knee arthroscopy: intra-articular morphine, intra-articular bupivacaine, or subcutaneous morphine? Reg Anesth 22:233–238PubMedCrossRef
12.
Chirwa SS, MacLeod BA, Day B (1989) Intraarticular bupivacaine (Marcaine) after arthroscopic meniscectomy: a randomized double-blind controlled study. Arthroscopy 5:33–35PubMedCrossRef
13.
Chu CR, Izzo NJ, Coyle CH et al (2008) The in vitro effects of bupivacaine on articular chondrocytes. J Bone Joint Surg Br 90:814–820PubMedCrossRef
14.
Cook TM, Tuckey JP, Nolan JP (1997) Analgesia after day-case knee arthroscopy: double-blind study of intra-articular tenoxicam, intra-articular bupivacaine and placebo. Br J Anaesth 78:163–168PubMedCrossRef
15.
Craft DV, Good RP (1994) Delayed hypersensitivity reaction of the knee after injection of arthroscopy portals with bupivacaine (Marcaine). Arthroscopy 10:305–308PubMedCrossRef
16.
Datta R, Madhusudanan TP (2004) Pain relief following Arthroscopy: a comparative study of Intra-articular Bupivacaine, Morphine and Neostigmine. Armed Forces Med J India 60:123–127CrossRef
17.
De Andres J, Valia JC, Barrera L et al (1998) Intra-articular analgesia after arthroscopic knee surgery: comparison of three different regimens. Eur J Anaesthesiol 15:10–15PubMed
18.
Dragoo JL, Braun HJ, Kim HJ et al (2012) The in vitro chondrotoxicity of single-dose local anesthetics. Am J Sports Med 40:794–799PubMedCrossRef
19.
Dragoo JL, Korotkova T, Kanwar R et al (2008) The effect of local anesthetics administered via pain pump on chondrocyte viability. Am J Sports Med 36:1484–1488PubMedCrossRef
20.
Dragoo JL, Korotkova T, Kim HJ et al (2010) Chondrotoxicity of low pH, epinephrine, and preservatives found in local anesthetics containing epinephrine. Am J Sports Med 38:1154–1159PubMedCrossRef
21.
Elsharnouby NM, Eid HE, Abou Elezz NF et al (2008) Intraarticular injection of magnesium sulphate and/or bupivacaine for postoperative analgesia after arthroscopic knee surgery. Anesth Analg 106:1548–1552PubMedCrossRef
22.
Eroglu A, Saracoglu S, Erturk E et al (2010) A comparison of intraarticular morphine and bupivacaine for pain control and outpatient status after an arthroscopic knee surgery under a low dose of spinal anaesthesia. Knee Surg Sports Traumatol Arthrosc 18:1487–1495PubMedCrossRef
23.
Farouk S, Aly A (2009) A comparison of intra-articular magnesium and/or morphine with bupivacaine for postoperative analgesia after arthroscopic knee surgery. J Anesth 23:508–512PubMedCrossRef
24.
Foley NC, Bhogal SK, Teasell RW, Bureau Y, Speechley MR (2006) Estimates of quality and reliability with the physiotherapy evidence-based database scale to assess the methodology of randomized controlled trials of pharmacological and nonphar-macological interventions. Phys Ther 86:817–824 (Maxillofac Surg 59:979–983, 983–984)
25.
Geutjens G, Hambidge JE (1994) Analgesic effects of intraarticular bupivacaine after day-case arthroscopy. Arthroscopy 10:299–300PubMedCrossRef
26.
Grabowska-Gaweł A, Gaweł K, Hagner W et al (2003) Morphine or bupivacaine in controlling postoperative pain in patients subjected to knee joint arthroscopy. Ortop Traumatol Rehabil 5:758–762PubMed
27.
Hansen TB, Jakobsen IA (2008) Intra-articular bupivacaine as treatment for postoperative pain after arthroscopy of the wrist. Scand J Plast Reconstr Surg Hand Surg 42:313–315PubMedCrossRef
28.
Haynes TK, Appadurai IR, Power I et al (1994) Intra-articular morphine and bupivacaine analgesia after arthroscopic knee surgery. Anaesthesia 49:54–56PubMedCrossRef
29.
Henderson RC, Campion ER, DeMasi RA et al (1990) Postarthroscopy analgesia with bupivacaine. A prospective, randomized, blinded evaluation. Am J Sports Med 18:614–617PubMedCrossRef
30.
Izdes S, Orhun S, Turanli S et al (2003) The effects of preoperative inflammation on the analgesic efficacy of intraarticular piroxicam for outpatient knee arthroscopy. Anesth Analg 97:1016–1019PubMedCrossRef
31.
Karamanlioğlu B, Alagöl A, Turan FN (2005) Preemptive oral rofecoxib plus postoperative intraarticular bupivacaine for pain relief after arthroscopic knee surgery. Agri 17:29–33PubMed
32.
Khoury GF, Chen AC, Garland DE et al (1992) Intraarticular morphine, bupivacaine, and morphine/bupivacaine for pain control after knee videoarthroscopy. Anesthesiology 77:263–266PubMedCrossRef
33.
Koltka K, Koknel-Talu G, Asik M et al (2011) Comparison of efficacy of intraarticular application of magnesium, levobupivacaine and lornoxicam with placebo in arthroscopic surgery. Knee Surg Sports Traumatol Arthrosc 19:1884–1889PubMedCrossRef
34.
Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62:e1–e34PubMedCrossRef
35.
Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M (2003) Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 83:713–721PubMed
36.
Marchal JM, Delgado-Martinez AD, Poncela M et al (2003) Does the type of arthroscopic surgery modify the analgesic effect of intraarticular morphine and bupivacaine? A preliminary study. Clin J Pain 19:240–246PubMedCrossRef
37.
Marret E, Gentili M, Bonnet MP et al (2005) Intra-articular ropivacaine 0.75% and bupivacaine 0.50% for analgesia after arthroscopic knee surgery: a randomized prospective study. Arthroscopy 21:313–316PubMedCrossRef
38.
39.
Milligan KA, Mowbray MJ, Mulrooney L et al (1988) Intra-articular bupivacaine for pain relief after arthroscopic surgery of the knee joint in daycase patients. Anaesthesia 43:563–564PubMedCrossRef
40.
Morgenthaler K, Bauer C, Ziegeler S et al (2007) Intra-articular bupivacaine following hip joint arthroscopy. Effect on postoperative pain. Anaesthesist 56:1128–1132PubMedCrossRef
41.
Møiniche S, Mikkelsen S, Wetterslev J et al (1999) A systematic review of intra-articular local anesthesia for postoperative pain relief after arthroscopic knee surgery. Reg Anesth Pain Med 24:430–437PubMedCrossRef
42.
Osborne D, Keene G (1993) Pain relief after arthroscopic surgery of the knee: prospective, randomized, and blinded assessment of bupivacaine and bupivacaine with adrenaline. Arthroscopy 9:177–180PubMedCrossRef
43.
Park J, Sutradhar BC, Hong G et al (2011) Comparison of the cytotoxic effects of bupivacaine, lidocaine, and mepivacaine in equine articular chondrocytes. Vet Anaesth Analg 38:127–133PubMedCrossRef
44.
Pavlin DJ, Chen C, Penaloza DA et al (2004) A survey of pain and other symptoms that affect the recovery process after discharge from an ambulatory surgery unit. J Clin Anesth 16:200–206PubMedCrossRef
45.
Piper SL, Kim HT (2008) Comparison of ropivacaine and bupivacaine toxicity in human articular chondrocytes. J Bone Joint Surg Am 90:986–991PubMedCrossRef
46.
Raja SN, Dickstein RE, Johnson CA (1992) Comparison of postoperative analgesic effects of intraarticular bupivacaine and morphine following. Anesthesiology 77:1143–1147PubMedCrossRef
47.
RapleyJH Beavis RC, Barber FA (2009) Glenohumeral chondrolysis after shoulder arthroscopy associated with continuous bupivacaine infusion. Arthroscopy 25:1367–1373CrossRef
48.
Reuben SS, Sklar J (2000) Pain management in patients who undergo outpatient arthroscopic surgery of the knee. J Bone Joint Surg Am 82:1754–1766PubMed
49.
Ruwe PA, Klein I, Shields CL (1995) The effect of intraarticular injection of morphine and bupivacaine on postarthroscopic pain control. Am J Sports Med 23:59–64PubMedCrossRef
50.
Senthilkumaran S, Tate R, Read JRM et al (2010) Intra-articular morphine and bupivacaine for post-operative analgesia in anterior cruciate ligament reconstruction: a prospective randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 18:731–735PubMedCrossRef
51.
Shelbourne KD, Nitz P (1992) Accelerated rehabilitation after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 15:256–264PubMedCrossRef
52.
Smith I, Van Hemelrijck J, White PF et al (1991) Effects of local anesthesia on recovery after outpatient arthroscopy. Anesth Analg 73:536–539PubMed
53.
Solheim N, Rosseland LA, Stubhaug A (2006) Intra-articular morphine 5 mg after knee arthroscopy does not produce significant pain relief when administered to patients with moderate to severe pain via an intra-articular catheter. Reg Anesth Pain Med 31:506–513PubMedCrossRef
54.
55.
Toivonen J, Pitko VM, Rosenberg PH (2002) Comparison between intra-articular bupivacaine with epinephrine and epinephrine alone on short-term and long-term pain after knee arthroscopic surgery under general anesthesia in day-surgery patients. Acta Anaesthesiol Scand 46:435–440PubMedCrossRef
56.
Tompkins M, Plante M, Monchik K et al (2011) The use of a non-benzodiazepine hypnotic sleep-aid (Zolpidem) in patients undergoing ACL reconstruction: a randomized controlled clinical trial. Knee Surg Sports Traumatol Arthrosc 19:787–791PubMedCrossRef
57.
Varrassi G, Marinangeli F, Ciccozzi A et al (1999) Intra-articular buprenorphine after knee arthroscopy: a randomised, prospective, double-blind study. Acta Anaesthesiol Scand 43:51–55PubMedCrossRef
58.
Webb ST, Ghosh S (2009) Intra-articular bupivacaine: potentially chondrotoxic? Br J Anaesth 102:439–441PubMedCrossRef
59.
Zeidan A, Kassem R, Nahleh N et al (2008) Intraarticular tramadol-bupivacaine combination prolongs the duration of postoperative analgesia after outpatient arthroscopic knee surgery. Anesth Analg 107:292–299PubMedCrossRef
Metadata
Title
Single-dose intra-articular bupivacaine after knee arthroscopic surgery: a meta-analysis of randomized placebo-controlled studies
Authors
Jie Wei
Hao-bin Yang
Jia-bi Qin
Fan-jing Kong
Tu-bao Yang
Publication date
01-07-2014
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 7/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-013-2543-7

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