Effects of intraarticular tramadol, magnesium and ketamine on postoperative pain in arthroscopic meniscectomy
Efeitos de tramadol, magnésio e cetamina por via intra-articular sobre a dor pós-operatória em meniscectomia artroscópica
Nevriye Salman, Bilge Olgunkeleş, Umut Bektaş, Derviş Güner, Meltem Bektas, Şadan Ay, Sumru Şekerci
Abstract
Abstract Objective: Postoperative pain control is important in terms of early recovery and rehabilitation in arthroscopic meniscectomy. For this purpose, we aimed to compare the effects of intraarticular tramadol, magnesium, and ketamine with combinations of pericapsular bupivacaine on postoperative pain and recovery in arthroscopic meniscectomy. Methods: Ninety patients who underwent arthroscopic meniscectomy were enrolled in the study. Group T was given tramadol, Group K was given ketamine, and Group M was given magnesium reconstituted intraarticularly, and all groups received periarticular bupivacaine. Comparisons were made in terms of the patients' postoperative Visual Analogue Scale scores with and without movement, need for additional analgesics, first analgesic time, mobilization times, adverse effects, and satisfaction with the analgesics. Results: The Visual Analogue Scale scores were lowest in Group T at 0 minutes, and were higher in the 15th and 30th minutes and 1st, 2nd, and 6th hours. Visual Analogue Scale values with movement were found to be high in Group M at 0 and 15 minutes, but they were found to be higher in group T in the 30th minute, 1st, 2nd and 6th hour. The groups were similar in terms of postoperative additional analgesic use, number of analgesic use, and satisfaction with analgesics; however, the first analgesic time was earlier in Group M, and the first mobilization time was earlier in Group K. Conclusion: Intraarticular ketamine enables early mobilization and less need for additional analgesics, it also provides a better analgesic effect in comparison with intraarticular tramadol and magnesium.
Keywords
Resumo
Resumo Objetivo: O controle da dor pós-operatória é importante para recuperação e reabilitação precoces em meniscectomia artroscópica. Portanto, nosso objetivo foi comparar os efeitos de tramadol, magnésio e cetamina administrados por via intra-articular em associação com bupivacaína pericapsular sobre a dor e a recuperação após meniscectomia artroscópica. Métodos: Noventa pacientes submetidos à meniscectomia artroscópica foram incluídos no estudo. O Grupo T recebeu tramadol, o Grupo K recebeu cetamina e o Grupo M recebeu magnésio em doses reconstituídas por via intra-articular e todos os grupos receberam bupivacaína por via periarticular. As avaliações foram feitas mediante comparação dos escores em escala visual analógica no pós-operatório dos pacientes em movimento e em repouso, necessidade de analgésicos adicionais, tempo até a primeira necessidade de analgésico, tempo de mobilização, efeitos adversos e satisfação com os analgésicos. Resultados: Os escores da escala visual analógica foram menores no minuto zero e maiores nos minutos 15 e 30 e nas horas 1, 2 e 6 no Grupo T. Os escores da escala visual analógica em movimento foram maiores nos minutos zero e 15 no Grupo M e maiores no minuto 30 e nas horas 1, 2 e 6 no Grupo T. Os escores dos grupos foram semelhantes em relação à necessidade de analgésico adicional no pós-operatório, ao consumo de analgésico e à satisfação com os analgésicos, mas os tempos até a primeira necessidade de analgesia e até a primeira mobilização foram mais curtos nos grupos M e K, respectivamente. Conclusão: A administração intra-articular de cetamina permite mobilização precoce e diminui a necessidade de analgésicos adicionais, além de proporcionar um melhor efeito analgésico em comparação com tramadol e magnésio por via intra-articular.
Palavras-chave
References
Beyzadeoglu T, Yilmaz C, Bekler H. Intraarticular tramadol plus pericapsular incisional bupivacaine provides better analgesia than intraarticular plus pericapsular incisional bupivacaine after outpatient arthroscopic partial meniscectomy. Knee Surg Sports Traumatol Arthrosc. 2007;15:564-8.
Ayoglu H, Altunkaya H, Bayar A. The effect of intraarticular combinations of tramadol and ropivacaine with ketamine on postoperative pain after arthroscopic meniscectomy. Arch Orthop Trauma Surg. 2010;130:307-12.
Kargi E, Babuccu O, Altunkaya H. Tramadol as a local anaesthetic in tendon repair surgery of the hand. J Int Med Res. 2008;36:971-8.
Jou IM, Chu KS, Chen HH. The effects of intrathecal tramadol on spinal somatosensory-evoked potentials and motor-evoked responses in rats. Anesth Analg. 2003;96:783-8.
Zeidan A, Kassem R, Nahleh N. Intraarticular tramadol-bupivacaine combination prolongs the duration of postoperative analgesia after outpatient arthroscopic knee surgery. Anesth Analg. 2008;107:292-9.
Tuncer B, Babacan A, Arslan M. Preemptive intraarticular tramadol for pain control after arthroscopic knee surgery. Agrı. 2007;19:42-9.
Alagöl A, Calpur OU, Kaya G. The use of intraarticular tramadol for postoperative analgesia after arthroscopic knee surgery: a comparison of different intraarticular and intravenous doses. Knee Surg Sports Traumatol Arthrosc. 2004;12:184-8.
Petrenko AB, Yamakura T, Baba H. The role of N-methyl-d-aspartate (NMDA) receptors in pain: a review. Anesth Analg. 2003;97:1108-16.
Webb AR, Skinner BS, Leong S. The addition of a small-dose ketamine infusion to tramadol for postoperative analgesia: a double-blinded, placebo-controlled, randomized trial after abdominal surgery. Anesth Analg. 2007;104:912-7.
Levaux Ch, Bonhomme V, Dewandre PY. Effect of intraoperative magnesium sulphate on pain relief and patient comfort after major lumbar orthopaedic surgery. Anaesthesia. 2003;68:131-5.
Koinig H, Wallner T, Marhofer P. Magnesium sulfate reduces intra- and postoperative analgesic requirements. Anesth Analg. 1998;87:206-10.
Baverel L, Cucurulo T, Lutz C. Anesthesia and analgesia methods for outpatient anterior cruciate ligament reconstruction. Orthop Traumatol Surg Res. 2016;102:251-5.
Hosseini H, Abrisham SM, Jomeh H. The comparison of intraarticular morphine-bupivacaine and tramadol-bupivacaine in postoperative analgesia after arthroscopic anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2012;20:1839-44.
Borner M, Burkle H, Trojan S. Intra-articular ketamine after arthroscopic knee surgery. Optimisation of postoperative analgesia. Anaesthesist. 2007;56:1120-7.
Rosseland LA, Stubhaug A, Sandberg L. Intraarticular (IA) catheter administration of postoperative analgesics. A new trial design allows evaluation of baseline pain, demonstrates large variation in need of analgesics, and finds no analgesic effect of IA ketamine compared with IA saline. Pain. 2003;104:25-34.
Kopsky DJ, Keppel Hesselink JM, Bhaskar A. Analgesic effects of topical ketamine. Minerva Anestesiol. 2015;81:440-9.
Dal D, Tetik O, Altunkaya H. The efficacy of intra-articular ketamine for postoperative analgesia in outpatient arthroscopic surgery. Arthroscopy. 2004;20:300-5.
Cairns BE, Swensson P, Wang K. Activation of peripheral NMDA receptors contributes to human pain and rat afferent discharges evoked by injection of glutamate into the masseter muscle. J Neurophysiol. 2003;90:2098-105.
Elsharnouby NM, Eid HE, Elezz NFA. Intraarticular injection of magnesium sulphate and/or bupivacaine for postoperative analgesia after arthroscopic knee surgery. Anesth Analg. 2008;106:1548-52.
Kronenberg RH. Ketamine as an analgesic: parenteral, oral, rectal, subcutaneous, transdermal and intranasal administration. J Pain Palliat Care Pharmacother. 2002;16:27-35.
Bondok RS, Abd El-Hady AM. Intra-articular magnesium is effective for postoperative analgesia in arthroscopic knee surgery. Br J Anaesth. 2006;97:389-92.
Ozturk AM, Ergun MA, Demir T. Ketamine is toxic to chondrocyte cell cultures. Bone Joint J. 2014;96:989-94.
Batra YK, Mahajan R, Bangalia SK. Bupivacaine/ketamine is superior to intraarticular ketamine analgesia following arthroscopic knee surgery. Can J Anaesth. 2005;52:832-6.
Isik C, Demirhan A, Yetis T. Efficacy of intraarticular application of ketamine or ketamine-levobupivacaine combination on post-operative pain after arthroscopic meniscectomy. Knee Surg Sports Traumatol Arthrosc. 2015;23:2721-6.
Stueber T, Karsten J, Stoetzer C. Differential cytotoxic properties of drugs used for intra-articular injection on human chondrocytes: an experimental in-vitro study. Eur J Anaesthesiol. 2014;31:640-5.
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email