Preemptive analgesia with intra-articular pethidine reduces pain after arthroscopic knee surgery

Authors
Sayed Jalal Hashemi
Hasanali Soltani
Sayed Morteza Heidari
Mahmoud Rezakohanfekr
Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Postoperative pain relief is important in procedures of the lower extremity. Several previous studies have evaluated the efficacy of intra-articular (IA) pethidine as a compound, which has local anesthetic and opioid agonist properties, on postoperative pain relief in arthroscopic knee surgery (AKS). This study compared the postoperative analgesic effect of pre- and post-surgical IA pethidine administration in AKS.
Materials and Methods: Seventy-five patients of American Society of Anesthesiologists (ASA) I and II undergoing AKS with general anesthesia were enrolled in this double-blind study. Patients were randomized in three equal groups to receive either 50 mg IA pethidine before surgical incision incision and saline after skin closure (PS), saline before surgical incision and pethedine after skin closure (SP), and only saline at two different times (SS). In each patient with operated knee joint, pain at rest and joint movement was evaluated at 1, 2, 6, 12, and 24 h after surgery completion using Visual Analog Scale (VAS). Data were analyzed using analysis of variance (ANOVA)-repeated measure, t-paired, and Chi-square tests.
Results: Postoperative pain score at rest and joint movement in PS group was significantly lower than those in other groups. The time (Mean ± SD) between completion of operation and patient's request for morphine, total morphine consumption (Mean ± SD) in postoperative 24 h, and the numbers of patients requesting analgesic in PS, SP, SS, groups were: 5.2 ± 1.3, 3.3 ± 1.5, and 2 ± 1.3 h (P < 0.05); 4.4 ± 2.4, 8.7 ± 2, and 11.6 ± 4.4 mg (P < 0.05); 11, 18, and 21 persons (P < 0.05), respectively.
Conclusion: The present study shows that preemptive intra-articular pethidine 50 mg injection is more effective than preventive injection for postoperative pain relief at rest and joint movement in arthroscopic knee surgery.
Keywords
Arthroscopy
intra-articular
knee
pain after surgery
pethidine
1. Simanski CJ. Pain therapy for the lower extremities. Orthopade 2008;37:959-60, 962-9.  Back to cited text no. 1
    
2. Drosos GI, Stavropoulos NI, Katsis A, Kesidis K, Kazakos K, Verettas DA. Post-operative pain after knee arthroscopy and related factors. Open Orthop J 2008;13;2:110-4.  Back to cited text no. 2
    
3. Söderlund A, Boreus LO, Westman L, Engström B, Valentin A, Ekblom A. A comparison of 50, 100 and 200 mg of intra-articular pethidine during knee joint surgery, a controlled study with evidence for local demethylation to norpethidine. Pain 1999;80:229-38.  Back to cited text no. 3
    
4. Samoladas EP, Chalidis B, Fotiadis H, Terzidis I, Ntobas T, Koimtzis M. The intra-articular use of ropivacaine for the control of post knee arthroscopy pain. J Orthop Surg Res 2006;23:1-17.  Back to cited text no. 4
    
5. Batra YK, Mahajan R, Kumar S, Rajeev S, Singh Dhillon M. A dose-ranging study of intraarticular midazolam for pain relief after knee arthroscopy. Anesth Analg 2008;107:669-72.  Back to cited text no. 5
    
6. Grabowska-Gawe³ A, Gawe³ K, Hagner W, Biliñski PJ. Morphine or bupivacaine in controlling postoperative pain in patients subjected to knee joint arthroscopy. Ortop Traumatol Rehabil 2003;30;5:758-62.  Back to cited text no. 6
    
7. Cagla OzbakisAkkurt B, Inanoglu K, Kalaci A, Turhanoglu S, Asfuroglu Z, Tumkaya F. Effects of intravenous small dose ketamine and midazolam on postoperative pain following knee arthroscopy. Pain Pract 2009;9:289-95.  Back to cited text no. 7
    
8. Karamanlioðlu B, Alagöl A, Turan FN. Preemptive oral rofecoxib plus postoperative intraarticular bupivacaine for pain relief after arthroscopic knee surgery. Agri 2005;17:29-33.  Back to cited text no. 8
    
9. Reuben SS, Sklar J, El-Mansouri M. The preemptive analgesic effect of intraarticular bupivacaine and morphine after ambulatory arthroscopic knee surgery. Anesth Analg 2001;92:923-6.  Back to cited text no. 9
    
10. Oldroyd GJ, Tham EJ, Power I. An investigation of the local anaesthetic effects of pethidine in volunteers. Anaesthesia 1994;49:503-6.  Back to cited text no. 10
    
11. Campiglia L, Consales G, De Gaudio AR. Pre-emptive analgesia for postoperative pain control: A review. Clin Drug Investig 2010;30:15-26.  Back to cited text no. 11
    
12. Woolf CJ, Chong MS. Preemptive analgesia--treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 1993;77:362-79.  Back to cited text no. 12
    
13. Lascelles BD, Cripps PJ, Jones A, Waterman AE. Post-operative central hypersensitivity and pain: The pre-emptive value of pethidine for ovariohysterectomy. Pain 1997;73:461-71.  Back to cited text no. 13
    
14. Tuncer B, Babacan A, Arslan M. Preemptive intraarticular tramadol for pain control after arthroscopic knee surgery. Agri 2007;19:42-9.  Back to cited text no. 14
    
15. Hube R, Tröger M, Rickerl F, Muench EO, von Eisenhart-Rothe R, Hein W, et al. Pre-emptive intra-articular administration of local anaesthetics/opiates versus postoperative local anaesthetics/opiates or local anaesthetics in arthroscopic surgery of the knee joint: A prospective randomized trial. Arch Orthop Trauma Surg 2009;129:343-8.  Back to cited text no. 15
    
16. Dahl JB, Møiniche S. Pre-emptive analgesia. Br Med Bull 2004;71:13-27.  Back to cited text no. 16
    
17. Hurley RW, Wu CL. Acute Postoperative Pain. In: Miller R, editor. Miller's Anesthesia. 7 th ed. Philadelphia: Churchill Livingstone Elsevier; 2010. p. 2757-87.  Back to cited text no. 17
    
18. Kissin I. Preemptive analgesia. Anesthesiology 2000;93:1138.  Back to cited text no. 18
    
Advanced Biomedical Research
Volume 2013, March
March 2013
Pages 1-6