The present comparative study was designed to evaluate the
postoperative (PO) analgesia of preemptive intra-articular (IA)
injection of neostigmine or tramadol in comparison to bupivacaine in
patients undergoing therapeutic knee arthroscopy. The study included
60 patients (31 males and. 19 females; 53 patients were ASA I and 7
patients were ASA II). Patients were randomly allocated into 3 equal
groups according to IA medication used; Neostigmine group received
500 ug neostigmine plus BupivacaineO.25%,Tramadol group received
100 mg tramadol plus BupivacineO.25% and Bupivacaine group
received30 ml of 0.25% bupivacaine; all medications were injected
3D-minutes prior to skin incision. Arrival at the postanesthetic care
unit (PACU) was recorded as time zero. Postoperative pain was
assessed using the visual analog scale (VAS); a 100-mm scale
included 0 as an indication of "no pain at all", and 100 as an indication
of "the worst possible pain" at 1,4,8, 12, and 24 hours after operation.
Duration of effective analgesia was measured from the time o (T-O)
until first use of analgesic rescue medication at VAS score 2:40 and
the total amount of analgesic rescue medication was assessed over
24h. Combination of tramadol or neostigmine with bupivacaine
provided significantly superior PO analgesia in comparison to
bupivacaine only manifested as longer duration of PO analgesia and
lower pain VAS scores extending till 12-hrswith neostigmine and 24-
hrs with tramadol in comparison to only 4-hrs PO analgesia with
bupivacaine with a significant reduction of requests for and dose of
rescue analgesia in neostigmine and tramadol groups, compared to
bupivacaine group. Tramadol provided more profound analgesic effect
than neostigmine manifested as significantly longer duration of
analgesia compared to bupivacaine or neostigmine groups. Mean of
total VAS score recorded in neostigmine and tramadol groups was
significantly lower compared to that recorded in bupivacaine group
with a non-significant difference in favor of tramado!. There were no
differences between the studied groups regarding the frequency of PO
adverse effects throughout the follow-up period. In conclusion,
preemptive intra-articular analgesia is an effective postoperative pain
control modality and combination therapy is more effective than
bupivacaine alone. Combination of tramadol and bupivacaine
provided superior postoperative analgesia and spares rescue analgesia
consumption. |
