Effect of preemptive multimodal analgesia for arthroscopic knee ligament repair
| Autor: | Nicholas Cicutti, Kevin C. Dennehy, Donald H. Johnson, Barbara Krepski, Anne C.P. Lui, Ola P. Rosaeg |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Adult
Male medicine.medical_specialty Epinephrine medicine.medical_treatment Analgesic Injections Intra-Articular Pacu Arthroscopy Double-Blind Method Femoral nerve Preoperative Care medicine Humans Ropivacaine Anesthetics Local Anterior Cruciate Ligament Pain Measurement Postoperative Care Analgesics Pain Postoperative Morphine biology Patient-controlled analgesia business.industry Anti-Inflammatory Agents Non-Steroidal Analgesia Patient-Controlled Nerve Block General Medicine biology.organism_classification Amides Surgery Analgesics Opioid Ketorolac Anesthesiology and Pain Medicine Anesthesia Injections Intravenous Nerve block Female business Femoral Nerve medicine.drug |
| Zdroj: | Regional Anesthesia and Pain Medicine. 26:125-130 |
| ISSN: | 1098-7339 |
| DOI: | 10.1053/rapm.2001.20982 |
| Popis: | Background and Objectives Administration of analgesic medication before surgery, rather than at the completion of the procedure, may reduce postoperative pain. Similarly, administration of multiple analgesics, with different mechanisms of action, may provide improved postoperative pain control and functional recovery. The purpose of our study was to compare pain scores and intravenous opioid consumption after outpatient anterior cruciate ligament (ACL) reconstruction in patients who received a multimodal drug combination (intravenous [IV] ketorolac, intra-articular morphine/ropivacaine/epinephrine, and femoral nerve block with ropivacaine) either before surgery or immediately at the completion of the surgical procedure. Methods Forty patients presenting for same-day arthroscopic ACL repair using a semitendinosis tendon graft were included in this study. The patients were randomized to receive the following drugs either 15 minutes before skin incision or immediately after skin closure: (1) Ketorolac 30 mg IV. (2) Intra-articular injection of 20 mL ropivacaine 0.25% + morphine 2 mg and epinephrine 1:200,000. (3) Femoral nerve block with 20 mL ropivacaine 0.25%. Verbal pain scores were obtained in the postanesthesia care unit (PACU) and on postoperative days 1, 3, and 7. IV patient controlled analgesia (PCA) morphine consumption in the PACU was also recorded. Results Verbal pain rating scores were lower in group I (preemptive) for 2.0 hours after arrival in the PACU. There was no difference between groups in pain scores on postoperative days 1, 3, and 7. Mean IV PCA morphine consumption in the PACU was lower in group I (6.4 mg) versus group II (12.3 mg), P Conclusion Preemptive, multimodal administration of our 3-component analgesic drug combination resulted in lower pain scores during the initial stay in the PACU unit and lower consumption of IV PCA morphine in the PACU. However, pain scores were similar in both groups on postoperative days 1, 3, and 7; thus, there was no measurable long-term advantage associated with preemptive multimodal drug administration. |
| Databáze: | OpenAIRE |
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