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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(02): 257-266
DOI: 10.1055/s-0040-1718514
Artigo Original
Pé e Tornozelo

Assessment of The Addition of Epinephrine to Intra-articular Bupivacaine for the Control of Acute Pain in Patients underwent to Anterior Cruciate Ligament Reconstruction[*]

Article in several languages: português | English
Marcos George de Souza Leão 
1   Departamento de Ortopedia e Traumatologia, Fundação Hospital Adriano Jorge, Manaus, AM, Brasil
,
Juscimar Carneiro Nunes 
2   Programa de Pós-Graduação em Cirurgia, Universidade Federal do Amazonas, Manaus, AM, Brasil
,
Ivan Tramujas da Costa e Silva 
2   Programa de Pós-Graduação em Cirurgia, Universidade Federal do Amazonas, Manaus, AM, Brasil
,
Alan Braga Perfeito 
1   Departamento de Ortopedia e Traumatologia, Fundação Hospital Adriano Jorge, Manaus, AM, Brasil
,
Wagner de Paula Rogério 
3   Serviço de Anestesiologia, Fundação Hospital Adriano Jorge, Manaus, AM, Brasil
,
Rafaela Brasil e Silva Nunes 
3   Serviço de Anestesiologia, Fundação Hospital Adriano Jorge, Manaus, AM, Brasil
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Abstract

Objective To evaluate postoperative pain, using the visual analog scale (VAS), in patients undergoing anterior cruciate ligament reconstruction (ACLR) and receiving intra-articular anesthetic solutions.

Methods The present is a randomized clinical trial with a sample of 48 patients divided into 4 groups: Group I (n = 12) – 20 mL of saline solution (control); Group II (n = 12) – 20 mL of 0.5% bupivacaine; Group III (n = 12) – 20 mL of 0.5% bupivacaine + 0.1 mg of epinephrine; and Group IV (n = 12) – 20 mL of saline solution + 0.1 mg of epinephrine. These solutions were injected into the knee at the end of the surgery. Pain was assessed using the VAS immediately and 6, 12, 24 and 48 hours after the procedure.

Results The VAS scores were highly variable among the groups. A Kruskal-Wallis analysis of variance (ANOVA), considering a level of significance of 5%, revealed that all intra-articular anesthetic solutions influenced the assessment of pain (p = 0.003), and that Group-III subjects presented less postoperative pain. There was no evidence of a higher or lower use of supplemental analgesic agents, or of adverse effects resulting from these anesthetic solutions.

Conclusion Bupivacaine combined with epinephrine was the most effective solution for pain control in patients undergoing ACLR, but with no statistically significant differences when compared to Group II (p = 0.547). There was no decrease or increase in the use of supplemental analgesics or in the occurrence of adverse systemic effects (p > 0.05).

Keywords

anterior cruciate ligament - pain assessment - analgesia - drug therapy - arthroscopy

Financial Support

There was no financial support from public, commercial, or non-profit sources.


* Work developed at the Orthopedics and Traumatology Department, Fundação Hospital Adriano Jorge, Cachoeirinha, Manaus, AM, Brazil.




Publication History

Received: 29 August 2019

Accepted: 06 July 2020

Article published online:
19 April 2021

© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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