Arthroscopy: The Journal of Arthroscopic & Related Surgery
The efficacy of intra-articular ketamine for postoperative analgesia in outpatient arthroscopic surgery
Section snippets
Methods
After obtaining informed written consent from eligible patients and getting an approval from the hospital review board, a double-blind, prospective, randomized and placebo-controlled study was undertaken to evaluate postoperative pain and analgesic profiles. Between August 1999 and February 2001, a group of 60 patients (35 men, 25 women) who underwent arthroscopic surgery at the Ankara City Hospital were included in this study. The age, height, and weight of the patients, surgery and tourniquet
Results
No significant differences were seen among the 4 groups in terms of age, height, weight, surgery, tourniquet times, and length of the anesthesia (Table 1). VAS scores of rest and 90° flexion for ketamine, bupivacaine, and neostigmine were lower than placebo for all time intervals Table 2, Table 3.
VAS scores for pain were significantly lower at postoperative 8, 12, 20, and 24 hours in ketamine group (I), at the postoperative 4, 8, 12, 16, 20, and 24 hours in the neostigmine group (II), at all
Discussion
Ketamine is a noncompetitive antagonist that blocks the ion channel, coupled to the phencyclidine site of the NMDA receptor. It inhibits the facilitated state of spinal processing caused by repetitive persistent small afferent (C-fiber) input, “wind-up,” and long-term potentiation of transmission.8 It also interacts with multiple binding sites, including NMDA and non-NMDA glutamate receptors, nicotinic receptors, and muscarinic cholinergic, and monoaminergic and opioid receptors.9 Other
Acknowledgements
Special thanks to Ülkü Aypar M.D., Professor in Anesthesiology and Chairman of the Hacettepe University Department of Anesthesiology and Reanimation, for her contributions.
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2017, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :The significant difference in VAS scores cannot be explained by the direct analgesic effect of bupivacaine, but it may be influenced by superior initial pain management, a more effective pain management loading dose, psychological factors related to the initial level of pain experienced after surgery, or other unknown factors. Additionally, previous studies have shown the effectiveness of intra-articular bupivacaine ranges up to 24 hours postoperatively.29,30 After the first 18 hours pain management, narcotics consumption remains important.
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