Advertisement
Original Article| Volume 25, ISSUE 9, P1019-1024, September 2009

Download started.

Ok

Anesthesia and Postoperative Analgesia After Intra-articular Injection of Warmed Versus Room-Temperature Levobupivacaine: A Double-Blind Randomized Trial

      Purpose

      This prospective, randomized, blinded study was designed to compare the effects of warmed versus room-temperature levobupivacaine in patients undergoing knee arthroscopy and partial meniscectomy.

      Methods

      Patients were randomly allocated into 2 groups of 16 patients each. In all patients the 2 portal sites were infiltrated with 10 mL of room-temperature mepivacaine (20 mg/mL). In the first group, patients underwent intra-articular injection of 20 mL of levobupivacaine (5 mg/mL) and 0.005-mg/mL epinephrine (1:200,000) at a temperature of 40°C ± 0.2°C, whereas in the second group the levobupivacaine and epinephrine were at room temperature (25°C ± 0.5°C). Pain was graded and recorded intraoperatively and postoperatively by use of a visual analog scale (VAS). Analgesia was supplemented if the VAS score was 4 cm or greater with morphine intraoperatively or ketorolac postoperatively.

      Results

      There were no significant differences between groups in intraoperative and postoperative VAS values. There was no need for morphine as a rescue dose in any patient during surgery. Eight patients treated with warmed levobupivacaine and seven patients treated with room-temperature levobupivacaine requested a single rescue dose of ketorolac (30 mg) postoperatively.

      Conclusions

      No compelling evidence exists to suggest that intra-articular injection of warmed levobupivacaine is more effective than room-temperature levobupivacaine for intraoperative anesthesia and postoperative analgesia in patients undergoing partial meniscectomy during knee arthroscopy.

      Level of Evidence

      Level I, randomized controlled trial.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Shapiro M.S.
        • Safran M.R.
        • Crockett H.
        • Finerman G.A.M.
        Local anesthesia for knee arthroscopy.
        Am J Sports Med. 1995; 23: 50-53
        • Jacobson E.
        • Forssblad M.
        • Rosenberg J.
        • Westman L.
        • Weidenhielm L.
        Can local anesthesia be recommended for routine use in elective knee arthroscopy?.
        Arthroscopy. 2000; 16: 183-190
        • Arai Y.C.
        • Ueda W.
        Warm steaming enhances the topical anesthetic effect of lidocaine.
        Anesth Analg. 2004; 98: 982-985
        • Heath P.J.
        • Brownlie G.S.
        • Herrick M.J.
        Latency of brachial plexus block.
        Anaesthesia. 1990; 45: 297-301
        • Arai Y.C.
        • Ikeuchi M.
        • Fukunaga K.
        • Ueda W.
        • Rimura T.
        • Komatsu T.
        Intra-articular injection of warmed lidocaine improves intraoperative anaesthetic and postoperative analgesic conditions.
        Br J Anaesth. 2006; 96: 259-261
        • Lacassie H.J.
        • Columb M.O.
        The relative motor blocking potencies of bupivacaine and levobupivacaine in labor.
        Anesth Analg. 2003; 97: 1509-1513
        • Gomoll A.H.
        • Kang R.W.
        • William J.M.
        • Bach B.R.
        • Cole B.J.
        Chondrolysis after continuous intra-articular bupivacaine infusion: An experimental model investigating chondrotoxicity in the rabbit shoulder.
        Arthroscopy. 2006; 22: 813-819
        • Casati A.
        • Putzu M.
        Bupivacaine, levobupivacaine and ropivacaine: Are they clinically different?.
        J Clin Anesth. 2005; 19: 247-268
        • Massey T.
        • Huang T.L.
        • Malinick R.
        • Zeli M.
        Serum lidocaine levels during arthroscopy using continuous irrigation with lidocaine.
        Clin Orthop Relat Res. 1988; : 182-184
        • Salinas F.V.
        • Liu S.L.
        • Scholz A.M.
        Analgesics: Ion channel ligands/sodium channel blockers/local anesthetics.
        in: Evers A.S. Maze M. Anesthetic pharmacology. Churchill Livingstone, Philadelphia2004: 507-535
        • Arai Y.C.
        • Ueda W.
        • Takimoto E.
        • Manabe M.
        The influence of hyperbaric bupivacaine temperature on the spread of spinal anesthesia.
        Anesth Analg. 2006; 102: 272-275
        • Santanen U.
        • Rautoma P.
        • Luurila H.
        • Ertola O.
        Intra-articular ropivacaine injection does not alleviate pain after day-case knee arthroscopy performed under spinal anaesthesia.
        Ann Chir Gynaecol. 2001; 90: 47-50
        • Møiniche S.
        • Mikkelsen S.
        • Wetterslev J.
        • Dahl J.B.
        A systemic review of intra-articular local anesthesia for postoperative pain relief after arthroscopic knee surgery.
        Reg Anesth Pain Med. 1999; 24: 430-437
        • Jacobson E.
        • Assarch H.
        • Cannerfelt R.
        • Anderson R.E.
        • Jacobsson J.G.
        The postoperative analgesic effects of intra-articular levobupivacaine in elective day-case arthroscopy of knee: A prospective, randomized, double-blind clinical study.
        Knee Surg Sports Traumatol Arthrosc. 2006; 14: 120-124
        • Armellin G.
        • Nardacchione R.
        • Ori C.
        Intra-articular sufentanil in multimodal analgesic management after arthroscopic anterior cruciate ligament reconstruction: A prospective, randomized double-blinded study.
        Arthroscopy. 2008; 24: 909-913
        • Zeidan A.
        • Kassem R.
        • Nahleh N.
        • El-khatib M.
        • Stuys M.M.
        • Baraka A.
        Intraarticular tramadol-bupivacaine combination prolongs the duration of postoperative analgesia after outpatient arthroscopic knee surgery.
        Anesth Analg. 2008; 107: 292-299
        • Beyzadeoglu T.
        • Yilmaz C.
        • Bekler H.
        • Gorce A.
        • Sayin M.M.
        Intraarticular tramadol plus pericapsular incisional bupivacaine provides better analgesia than intraarticular plus pericapsular incisional bupivacaine after outpatient arthroscopic meniscectomy.
        Knee Surg Sports Traumatol Arthrosc. 2007; 15: 564-568
        • Gomoll A.H.
        • Yanke A.B.
        • Kang R.W.
        • et al.
        Long-term effects of bupivacaine on cartilage in a rabbit shoulder model.
        Am J Sports Med. 2009; 37: 72-77
        • Nole R.
        • Munson N.M.
        • Fulkerson J.P.
        Bupivacaine and saline effects on articular cartilage.
        Arthroscopy. 1985; 1: 123-127
        • Banerjee S.S.
        • Pulido P.
        • Adelson W.S.
        • Fronek J.
        • Hoenecke H.R.
        The efficacy of continuous bupivacaine infiltration following arthroscopic rotator cuff repair.
        Arthroscopy. 2008; 24: 397-402
        • Heid F.
        • Müller N.
        • Piepho T.
        • et al.
        Postoperative analgesic efficacy of peripheral levobupivacaine and ropivacaine: A prospective randomized double-blind trial in patients after total knee arthroscopy.
        Anesth Analg. 2008; 106: 1559-1560
        • Jones R.E.
        • Gottlieb J.
        • Kaiser B.
        • Folf J.
        • Van Hal M.
        Comparison of two delivery methods of local anesthetic distribution after intra-articular knee injection.
        Orthopedics. 2006; 29: 439-442
        • Powell M.F.
        Stability of lidocaine in aqueous solution: Effect of temperature, pH, buffer, and metal ions on amide hydrolysis.
        Pharm Res. 1987; 4: 42-45
        • Ririe D.G.
        • Walker F.O.
        • James R.L.
        • Butterworth J.
        Effect of alkalinization of lidocaine on median nerve block.
        Br J Anaesth. 2000; 84: 163-168
        • Jones J.S.
        • Plzak C.
        • Wynn B.N.
        • Martin S.
        Effect of temperature and pH of bupivacaine for intradermal anesthesia.
        Am J Emerg Med. 1998; 16: 117-120
        • Mehta P.M.
        • Thieriot E.
        • Mehrota D.
        A simple technique to make bupivacaine a rapid-acting epidural anesthetic.
        Reg Anesth. 1987; 12: 135-138
        • McLeod G.A.
        Density of spinal anaesthetic solutions of bupivacaine, levobupivacaine, and ropivacaine with and without dextrose.
        Br J Anaesth. 2004; 92: 547-551
        • Kamaya H.
        • Hayes J.J.
        • Ueda I.
        Dissociation constants of local anesthetics and their temperature dependence.
        Anesth Analg. 1983; 62: 1025-1030
        • Cox C.R.
        • Checketts M.R.
        • Mackenzie N.
        • Scott N.B.
        • Bannister J.
        Comparison of S(-)bupivacaine with racemic (RS)-bupivacaine in supraclavicular brachial plexus block.
        Br J Anaesth. 1998; 80: 594-598
        • Ng H.P.
        • Nordström U.
        • Axelsson K.
        • et al.
        Efficacy of intra-articular bupivacaine, ropivacaine, or a combination of ropivacaine, morphine, and ketorolac on postoperative pain relief after ambulatory arthroscopic knee surgery: A randomized double-blind study.
        Reg Anesth Pain Med. 2006; 31: 26-33