Volume : VIII, Issue : VII, July - 2019

TO DETERMINE THE EFFECTIVENESS OF PERI-ARTICULAR INJECTION OF BUPIVACAINE, TRAMADOL, MAGNESIUM AND EPINEPHRINE FOR POSTOPERATIVE ANALGESIA IN KNEE JOINT ARTHROPLASTY

Dr. Vijay Krishnamurthy, Dr. Gopinath Ramachandran

Abstract :

AIM OF THE STUDY: To determine the effectiveness of peri–articular injection of bupivacaine, tramadol, magnesium and epinephrine for postoperative analgesia in knee joint arthroplasty INTRODUCTION: One of the analgesic techniques for pain management of knee joint arthroplasty is the peri–articular infiltration route.Excessive postoperative pain in arthroplasty of the knee may cause discomfort, delayed rehabilitation and discharge from the hospital. so,aggressive pain management in the early postoperative period is essential. Several medications are commonly injected peri–articularly and intraarticularly for postoperative analgesia after knee arthroplasty. Among them,bupivacaine(2,3,4,5,8) , tramadol(7), magnesium(1,6) have been shown to reduce postoperative pain considerably. MATERIAL AND METHODS: Following institute ethics committee approval,informed and written consent will be obtained from 60 patients of ASA class 1 and 2,scheduled to undergo knee arthroplasty of age 18–80 years and body mass index < 30. Exclusion criteria; patients with severe systemic disease (heart failure,renal insufficiency,or coagulopathy ) ,allergy or intolerance to study drugs, psychiatric illness, seizure disorder,regular narcotic use and refusal by the patient. All patients will be familiarized with a 10 cm visual analogue scale (VAS) preoperatively with 0: no pain,1–3:mild pain,4–6:moderate pain,7– 9:severe pain, and 10: the worst imaginable pain. Preoperative VAS scores will be obtained from all patients by asking the average intensity of pain at rest and on active movement of the knee. Premedication will be given with tab Ranitidine 150 mg tab and Alprazolam 0.25 mg. Patients will be assigned into three groups randomly. The drug will be blinded to the surgeon and the anesthetist.The drug will be given peri–articularly atleast 10 min before the release of the tourniquet. Group BTME will be given 150 mg of 0.5 % bupivacaine(30ml) ,150 mg of tramadol(3ml),1gm of magnesium(2ml) and 0.5 ml of adrenaline (1:1000)–35.5ml made upto 100 ml solution with normal saline. Group BTE will be given 150 mg of 0.5 % bupivacaine(30ml),150 mg of tramadol(3ml),and 0.5 ml of adrenaline (1:1000)–33.5ml made upto 100 ml solution.Group NS will receive 100 ml normal saline. The first aliquot of 20 ml of the mixture will be injected,just prior to implantation of the component,into the posterior aspect of the capsule as well as the medial and lateral collateral ligaments. Care will be taken to avoid excessive infiltration in the area of the common peroneal nerve. Then when the cement will be curing,the quadriceps and the retinacular tissues will be infiltrated with 20 ml of the mixture. Finally,the remaining 60 ml will be used to infiltrate the fat and subcuticular tissues. All peri–articular injections will be performed by the surgeon. In all groups regional anesthetic technique will be used. A dose of 3 ml of 0.5 % heavy bupivacaine +25 mcg fentanyl will be used. Neither intravenous narcotics nor ketamine will be administered during the surgery. The operations will be performed with the use of a tourniquet. A vacuum drain will be inserted before joint closure and will be removed on the first postoperative day. Standard monitoring techniques like ECG, blood pressure, pulse oximetry, capnography, heart rate will be used. All patients will receive oxygen via face mask throughout the procedure. After the operation, patients will be transferred to post operative ward where VAS pain scores will be obtained from all patients at 1,2,4,6,8,12 and 24 hrs. Incase of inadequate analgesia (VAS>5),patients of all groups will receive Tramadol 100 mg, i.m. as a rescue medication once it is requested upto a maximum dose of 150 mg. The time to first analgesic consumption will be recorded. Analgesic duration will be defined as the time from completion of surgery until the first request for Tramadol. Patients will be asked to indicate the degree of overall satisfaction with postoperative pain management on a 4– point satisfaction scale before discharge: 0=unsatisfactory/poor, 1=somewhat satisfactory/adequate,2=satisfactory/adequate, 3=very good, 4=excellent. Blood pressure, heart rate,respiratory rate,and oxygen saturation and the presence of side effects such as nausea, vomiting, sedation, hypotension, dizziness, headache, drymouth,allergic reaction, respiratory depression and urinary retention will be recorded postoperatively for each patient at the same time as pain measurements. Data will be analysed using Graph pad version 4,using nonparametric tests by Kruskal wallis test and using parametric tests by Anova test and Dunns multiple comparison test and performed post hoc test if P value is less than 0.05. P value less than 0.05 is considered statistically significant between groups.

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Article: Download PDF   DOI : 10.36106/ijsr  

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TO DETERMINE THE EFFECTIVENESS OF PERI-ARTICULAR INJECTION OF BUPIVACAINE, TRAMADOL, MAGNESIUM AND EPINEPHRINE FOR POSTOPERATIVE ANALGESIA IN KNEE JOINT ARTHROPLASTY, Dr. Vijay Krishnamurthy, Dr. Gopinath Ramachandran INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH : Volume-8 | Issue-7 | July-2019

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