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Randomized Controlled Trial
. 2012 Feb;20(2):239-44.
doi: 10.1007/s00167-011-1562-5. Epub 2011 Jun 1.

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

M M Campo  1 , G M M J Kerkhoffs, I N Sierevelt, R R Weeseman, H M Van der Vis, G H R Albers
Affiliations
Randomized Controlled Trial

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

M M Campo et al. Knee Surg Sports Traumatol Arthrosc. 2012 Feb.

Abstract

Purpose: In this double-blinded, randomised clinical trial, the aim was to compare the analgesic effects of low doses of intra-articular Bupivacaine and Ropivacaine against placebo after knee arthroscopy performed under general anaesthesia.

Methods: A total of 282 patients were randomised to 10 cc NaCl 0.9%, 10 cc Bupivacaine 0.5% or 10 cc Ropivacaine 0.75%. Patients received the assigned therapy by intra-articular injection after closure of the portal. Pain and satisfaction were measured at one, 4 h and 5-7 days after arthroscopy with Numerical Rating Scale (NRS) -scores. NSAID consumption was also recorded.

Results: One-h NRS-scores at rest were higher in the NaCl group compared with the Bupivacaine group (P < 0.01), 1 h NRS-scores in flexion were higher in the NaCl group compared with the Bupivacaine (P < 0.01) and Ropivacaine (P < 0.01) groups. NRS-satisfaction at 4 h was higher for the Bupivacaine group compared with the NaCl group (P = 0.01). Differences in NRS-scores were significant but low in magnitude. NSAID consumption was lower in the Bupivacaine group compared with the NaCl group (P < 0.01).

Conclusions: The results of this randomised clinical trial demonstrate improved analgesia after administration of low doses of intra-articular Bupivacaine and Ropivacaine after arthroscopy of the knee. Considering reports of Bupivacaine and Ropivacaine being chondrotoxic agents and the relatively small improvement on patient comfort found in this trial, it is advised to use systemic anaesthetic instead of intra-articular Bupivacaine or Ropivacaine for pain relief after knee arthroscopy.

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Figures

Fig. 1
Fig. 1
Flow diagram of the study
Fig. 2
Fig. 2
Median NRS (with interquartile ranges) for pain at rest. *P < 0.01
Fig. 3
Fig. 3
Median NRS (with interquartile ranges) for pain during flexion. *P < 0.01
Fig. 4
Fig. 4
Median NRS (with interquartile range) for satisfaction. *P = 0.01
See this image and copyright information in PMC

Comment in

  • Intraarticular local anesthetics: primum non nocere.
    Erkocak OF, Aydın BK, Celik JB. Erkocak OF, et al. Knee Surg Sports Traumatol Arthrosc. 2012 Oct;20(10):2125; author reply 2125-6. doi: 10.1007/s00167-012-1964-z. Epub 2012 Mar 28. Knee Surg Sports Traumatol Arthrosc. 2012. PMID: 22453308 Free PMC article. No abstract available.

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