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

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.

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.

El bloqueo interescalénico provee mejor calidad e índice de satisfacción que la analgesia intra-articular en el manejo del dolor postoperatorio en las cirugías de hombro / Interscalenic block provides for higher quality and improved satisfaction indexes than intraarticular analgesia in managing post surgery shoulder pain

Introducción: La analgesia intra-articular (AI) y el Bloqueo Interescalénico Continuo (BIEC) se utilizan para el manejo del dolor postoperatorio de las cirugías de hombro. La utilidad e índice de satisfacción obtenidos por su empleo son controversiales. Objetivo: Evaluar la utilidad de la AI versus el BIEC, comparando la calidad de la analgesia postoperatoria e índice de satisfacción e incidencia de complicaciones asociadas en pacientes beneficiarios de una cirugía del hombro asistido por artroscopia. Material y Método: Estudio prospectivo controlado de 47 pacientes ASA I-II, divididos en dos grupos. Grupop 1 AI: (n=23)Ropivacaína 0,20 por ciento 25 ml + Morfina 2mg.; Grupo 2: BIEC (n=24) Bupivacaína 0,0625 por ciento + Sufentanyl 1 up/ml con un débito de 7 ml/hr en IC. El dolor posquirúrgico se registro entre las 2 y 48 horas mediante Escala Visual Análoga (EVA). Se utilizó morfina endovenosa postoperatoria. Se registro el consumo de morfina, la incidencia de efectos adversos, el grado de satisfacción experimentados por los pacientes a las 48 hrs. Resultados: No hubo diferencias estadísticamente significativas en los parámetros demográficos de ambos grupos . El EVA postoperatorio y el consumo de Morfina (CM) entre las 4 y 12 horas fueron similares entre los dos grupos. El EVA entre las 24 y 48 hrs. fue significativamente menor en el grupo BIEC (25 +/- 4 mm) versus el grupo AI (47 +/-6 mm), (p=0,001). el CM entre las 24 y 48 hrs.fue de 13,5 +/- 3 mg en el grupo AI versus 6 +/- 3 mg en el grupo 2 (p=0,001). El grado de satisfacción experimentado por los pacientes fue superior en el grupo BIEC (p=0,03). HUbo mayor incidencia de náuseas y/o vómitos en el grupo AI. Conclusiones: El manejo del dolor postoperatorio mediante las técnicas de AI y BIEC es adecuado en cirugías de hombro. El BIEC se demuestra más efectivo que la AI después de las 12 hrs. postoperatorias, presentando los pacientes menor dolor y NVPO y un mayor índice de satisfacción.

Introduction: Intraarticular analgesia (IA) and Continuous Interscalenic Block (CIB) methods are used as analgesia in post shoulder surgery. The results obtained and the satisfaction index are rather controversial. Objective: To evaluate the usefulness of IA vs. CIB by comparing the post surgery analgesia and degree of satisfaction to the complications associated to arthroscopic shoulder surgery (ASS). Materials and Method: Controlled clinical trial with 47 ASS I and II patients separated in two groups. Group one, IA method: (n=23): 25ml of 0.2 percent ropivacaine plus 2 mgs of morphine; Group two, CIB method: (n=24) 0.0625 percent bupivacaine and 1 up/ml continuous sufentatil supply at 7ml/hr. Post surgery pain was recorded after 2 to 48 hours by means of a Visual Analogue Scale (VAS) and intravenous morphine was used for pain management. The use of morphine was recorded as well as adverse effects and the degree of satisfactions of patients after 48 hours. Results: There were no significant differences in demographic data between these two groups. Post surgery VAS and morphine use after 4 and 12 hours were similar between the two groups. VAS recorded after 24 and 48 hours was significantly lower in Group CIB (25+- 4mm) compared to Group IA (47+- 6mm), (p=0.001). The use of morphine from 24 to 48 hours was 13.5 +- 3mg in Group IA while use in Group CIB was 6 +- 3mg (p=0.01).The degree of satisfaction of patients was higher in Group CIB (p=0.03). Patients in Group IA experienced nausea and/or vomiting. Conclusions: The IA and CIB methods for pain management are adequate in post shoulder surgery. CIB proves to be more effective than IA after 12 hours with patients feeling less pain, a lower nvpo and a higher degree of satisfaction.