POSTOPERATIVE ANALGESIA FOR ARTHROSCOPIC KNEE SURGERY : A COMPARISON BETWEEN INTRA-ARTICULAR BUPIVACAINE IN COMBINATION WITH MAGNESIUM SULPHATE OR CLONIDINE
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Abstract
Background and Aim : Effective pain relief is important after diagnostic and therapeutic arthroscopic knee surgery to permit early discharge and to improve the comfort and mobility at home. The aim of this study was to assess the efficacy of Bupivacaine with either Clonidine or Magnesium sulphate injected intra-articularly for postoperative pain relief after arthroscopic knee surgery.
Methods : Sixty healthy consenting patients undergoing knee arthroscopy under subarachnoid block were randomized to receive one of the following drugs intra-articularly for postoperative pain relief. Group BC : 0.25% Bupivacaine 10 ml with Clonidine 1 μg /kg; Group BM : 0.25% Bupivacaine 10 ml with Magnesium sulphate 1 gm. Postoperatively, pain was assessed using VAS score. Time of rescue medication was noted.
Results : A longer delay was observed between intra-articular injection of study medication and first requirement of supplementary analgesic in group BM compared to group BC. Mean VAS score in Group BC was 4.930. Mean VAS score in Group BM was 3.819. In Group BC 13 patients opted for rescue medications within six hours of surgery and 17 patients opted for rescue medications after six hours of surgery, whereas in Group BM only 2 patients opted for rescue medications within six hours of surgery and 28 opted for rescue medications six hours after surgery. ( p-value 0.01 ). The Mean Time for Rescue Medication in Group BC is 296 minutes and in Group BM is 452 minutes and this difference observed is statistically significant (P value <.001). No significant side effects were noted.
Conclusion : When compared to clonidine, magnesium sulphate added as adjunct to bupivacaine in patients undergoing arthroscopic knee surgery, improve the quality and duration of postoperative analgesia.
Key words: Arthroscopic knee surgery, Intra articular Injection, Bupivacaine, Magnesium sulphate, Clonidine.