Comparison between the analgesic effects of intra-articular ropivacaine and ropivacaine plus fentanyl in arthroscopic knee surgery
Handan Birbiçer1, Şebnem Atıcı1, Nurcan Doruk1, İrfan Ayan2, Davud Yapıcı1, Uğur Oral1
1Mersin Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Mersin, Türkiye
2Mersin Üniversitesi Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Mersin, Türkiye
Keywords: Analgesics, opioid; anesthetics, local; arthroscopy; fentanyl; postoperative pain; injections, intra-articular; knee joint/surgery; pain measurement; ropivacaine.
Objectives: The effect of ropivacaine alone or in combination with fentanyl was evaluated on postoperative analgesia and analgesic requirements after arthroscopic knee surgery.
Patients and methods: The study included 60 ASA I-II patients (age range 18 to 65 years) undergoing arthroscopic meniscectomy. Following surgery under general anesthesia, the patients were randomly divided into three groups to receive intra-articular physiological saline (controls, n=20), ropivacaine 150 mg (n=20), or ropivacaine 150 mg with fentanyl 50 µg (n=20). The patients were monitored with respect to heart rate and mean arterial pressure, and pain was estimated using a visual analog scale (VAS) after 5, 15, and 30 minutes, and 1, 2, 4, 8, and 12 hours of operation. Analgesic requirements and adverse effects were recorded.
Results: There were no significant differences between the two ropivacaine groups with respect to VAS scores and analgesic need (p>0.05). Pain scores in the control group were at all times higher than both ropivacaine groups (p<0.05). A higher analgesic need was observed in the control group, compared to the ropivacaine (p=0.005) and ropivacaine plus fentanyl (p=0.01) groups. Analgesics were used in 10, three, and four patients in the control, ropivacaine, and ropivacaine plus fentanyl groups, respectively. Although analgesic requirement was confined to a single dose in both ropivacaine groups, three patients in the control group received further doses.
Conclusion: Intra-articular 150 mg ropivacaine alone was found effective for postoperative analgesia and the adjuvant use of fentanyl did not alter analgesia levels and analgesic needs.