Silviu Brill1, Miguel Plaza. 1. Department of Anesthesiology and Intensive Care, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Abstract
PURPOSE: We have evaluated randomized controlled trials of the administration of clonidine, neostigmine, steroids and non-steroidal anti-inflammatory agents intra-articularly as adjuvants to local anesthetic drugs after arthroscopic knee surgery. METHODS: Twenty-five studies were reviewed using specific inclusion criteria and, accordingly, included in the final assessment. These studies were assessed for pain scores, total analgesic consumption and time to first analgesic request to determine a possible peripheral effect, as opposed to possible systemic effects of an adjuvant administered intra-articularly. RESULTS: A total of 16 studies, met the inclusion criteria. These studies considered the use of non-steroidal anti-inflammatory drugs, steroids, neostigmine and clonidine. Ketorolac was used in four studies (for a total of 230 patients) and showed a significant improvement in analgesia. Clonidine has shown considerable analgesic effect, with minimal adverse effects. All seven studies assessed in this review were supportive (a total of 424 patients). Furthermore the addition of clonidine to bupivacaine or morphine was found to increase duration and quality of postoperative analgesia. CONCLUSIONS: Current evidence indicates that a variety of agents have synergistic effects when added to local anesthetics and there is evidence that the improvement in analgesia is, at least partially, through a local rather than a central mechanism. The results of this review suggest that clonidine and ketorolac, when administered intra-articulary after arthroscopic knee surgery, may reduce postoperative pain.
PURPOSE: We have evaluated randomized controlled trials of the administration of clonidine, neostigmine, steroids and non-steroidal anti-inflammatory agents intra-articularly as adjuvants to local anesthetic drugs after arthroscopic knee surgery. METHODS: Twenty-five studies were reviewed using specific inclusion criteria and, accordingly, included in the final assessment. These studies were assessed for pain scores, total analgesic consumption and time to first analgesic request to determine a possible peripheral effect, as opposed to possible systemic effects of an adjuvant administered intra-articularly. RESULTS: A total of 16 studies, met the inclusion criteria. These studies considered the use of non-steroidal anti-inflammatory drugs, steroids, neostigmine and clonidine. Ketorolac was used in four studies (for a total of 230 patients) and showed a significant improvement in analgesia. Clonidine has shown considerable analgesic effect, with minimal adverse effects. All seven studies assessed in this review were supportive (a total of 424 patients). Furthermore the addition of clonidine to bupivacaine or morphine was found to increase duration and quality of postoperative analgesia. CONCLUSIONS: Current evidence indicates that a variety of agents have synergistic effects when added to local anesthetics and there is evidence that the improvement in analgesia is, at least partially, through a local rather than a central mechanism. The results of this review suggest that clonidine and ketorolac, when administered intra-articulary after arthroscopic knee surgery, may reduce postoperative pain.