Effect of addition of fentanyl to intra-articular ketorolac for pain management in patients undergoing arthroscopic knee surgery

ABSTRACT

Arthroscopic Knee surgery is now one of the most commonly performed surgical procedures as its major advantage is the minimal surgical trauma to the knee joint. It is not associated with severe postoperative pain but providing the patients with adequate analgesia may affect the recovery profile. The goal of this study was to evaluate the effect of addition of fentanyl to ketorolac intra-articularly on the haemodynamic parameters, postoperative analgesia, possible postoperative complications and optimum discharge criteria in patients undergoing arthroscopic knee surgery. The study was conducted on 40 adult patients of either sex admitted at Mansoura university hospital knee unit for elective knee arthroscopy. Patients were randomly allocated into two equal groups [20 patients each] according to intra-articulary injected solution Ketorolac group [K] [10 mg ketorolac] and Ketorolac Fentanyl group [KF] [5 mg ketorolac + 50microg fentanyl] diluted in 20 ml 0.9% saline. All patients received general anaesthesia and all received the intra-articular study solution at the end of knee arthroscopy. Ten minutes before release of the tourniquet. Every patient was monitored intraoperativeiy and postoperatively for 24 hours with ECG non invasive blood pressure, and pulse oximetry. Duration of postoperative analgesia, Verbal Rating Pain Score, postoperative analgesic consumption and postoperative complications [sedation, respiratory depression, pruritus, nausea and vomiting] were recoded postoperatively for 24 hours. The patient's characteristics were comparable in the two groups regarding age, body weight, height and sex with no significant differences between the two groups. The duration of postoperative analgesia was significantly longer in KF group when compared with K group. Also the lotal consumption and the number of postoperative supplemental diciofenac doses were significantly decreased in KF group when compared with K group. Verbal Rating Scale Pain Score were significantly increased in K group at 12 hours when compared with the basal value, and significantly decreased in KF group when compared with K group at 12 hours. Haemodynamic parameters [mean arterial blood pressure and heart rate], oxygen saturation, sedation score and modified Al-dret score showed no significant differences either within each group or in between the two groups. No patient complained from nausea/ vomiting, pruritus or respiratory depression. No patient had a respiratory rate less than 10/minute. All patients in the two groups were discharged from hospital after the first 24 hours following surgery. Based on the previous results of our study, we can conclude that the addition of fentanyl to ketorolac intra-articularly significantly produces more prolonged duration of postoperative analgesia without any undesirable side effects in patients undergoing arthroscopic knee surgery