Intra-articular bupivacaine versus bupivacaine plus dexamethasone for analgesia after knee surgery

Abstract EN

Background : Postoperative pain is a common problem suffering the patients after knee surgery.

Treatment with intra-articular corticosteroid proparation has been advocated but the value of this approach had not been established.

We compared the efficacy of intra-articular dexamethasone plus bupivacaine with the efficacy of intra-articular bupivacaine alone to prevent post-operative pain after meniscectomy.

Methods : Sixty ASAI patients undergoing meniscectomy with general anesthesia were randomly assigned to receive intra-operative intra-articular bupivacaine, bupivacaine plus dexamethoasone, or placebo under double blinded condition.

The goup 1 (n = 20) received 10 ml of buplivacaine 0.5 % with epinephrine 1:2000000, group 2 (n = 20) received 8ml bupivacaine 0.5 % with epinephrine 1:200000 plus 2ml (8mg) dexamethosone and group 3 (n = 20) received 10ml of normal saline.

The patients were evaluated until 12 hours after the operation and pain levels at rest measured by a Visual Analogue Scale (VAS).

Results : During the first six hours after the operation, both combination of bupivacaine and dexamethasone and bupivacaine alone significantly reduced patient’s pain (P = 0.000) and during six to twelve hours after operation the patients in dexamethasone group had significantly lower pain scores comparing to other group (P = 0.037).

The low pain scores were associated with lower requirement of supplementary analgesics (P = 0.000).

Conclusion : Combination of intra-articular dexamethoasone and bupivacaine significantly reduces post-poertive pain and consumption of analgesics following meniscectomy than intra-articular bupivacaine alone.