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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 5, 601-603.
doi: 10.1302/0301-620X.91B5.21932  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Intra-articular injection versus portal infiltration of 0.5% bupivacaine following arthroscopy of the knee

A PROSPECTIVE, RANDOMISED DOUBLE-BLINDED TRIAL

D. Townshend, MBBS, FRCS(Orth), Specialist Registrar, Orthopaedics and Trauma1; K. Emmerson, MBBS, FRCS(Orth), Consultant Orthopaedic Surgeon1; S. Jones, MBBch, FRCS(Orth), Consultant Orthopaedic Surgeon1; P. Partington, MBBS, FRCS(Orth), Consultant Orthopaedic Surgeon1; and S. Muller, MD, FRCS(Orth), Consultant Orthopaedic Surgeon1

1 Department of Orthopaedics Wansbeck General Hospital, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK.

Correspondence should be sent to Mr D. Townshend; e-mail: davetownshend{at}hotmail.com

The administration of intra-articular local anaesthetic is common following arthroscopy of the knee. However, recent evidence has suggested that bupivacaine may be harmful to articular cartilage. This study aimed to establish whether infiltration of bupivacaine around the portals is as effective as intra-articular injection.

We randomised 137 patients to receive either 20 ml 0.5% bupivacaine introduced into the joint (group 1) or 20 ml 0.5% bupivacaine infiltrated only around the portals (group 2) following arthroscopy. A visual analogue scale was administered one hour post-operatively to assess pain relief. Both patients and observers were blinded to the treatment group. A power calculation was performed.

The mean visual analogue score was 3.24 (SD 2.20) in group I and 3.04 (SD 2.31) in group 2. This difference was not statistically significant (p = 0.62).

Infiltration of bupivacaine around the portals had an equivalent effect on pain scores at one hour, and we would therefore recommend this technique to avoid the possible chondrotoxic effect of intra-articular bupivacaine.




eLetters:

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Intra-articular injection versus portal infiltration
Ravi V Badge, et al.
J Bone Joint Surg Br Online, 8 Jun 2009 [Full text]
Intra-articular injection versus portal
George H Smith, et al.
J Bone Joint Surg Br Online, 10 Jul 2009 [Full text]

(c) British Editorial Society of Bone and Joint Surgery All Rights Reserved
Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General