Intra-articular analgesia with ketamine and tramadol; the effect of the type of surgery

ABSTRACT

Arthroscopies are most commonly performed on day case basis, but postoperative pain remains a problem as more complicated procedures are performed. This study was earned out on 60 adult ASA l-ll patients undergoing arthroscopic procedures. Patients were assigned into 2 equal groups; group I underwent low inflammatory surgeries, whereas group II had high inflammatory surgeries. Both groups were further subdivided randomly into 3 equal subgroups. Subgroup K received 0.5 mg kg[-1] ketamine intra-articularty, subgroup T received 100 mg tramadol intra-articularly and subgroup S received placebo. The following parameters were recorded; vital signs, first time to ask for analgesia, total rescue i.v pethidine given and VAS scores hourly for the 1[st] 6 hours, then 3-houhy till the end of the first postoperative day Group I showed significantly delayed onset of pain [p=.009]. lower pethidine consumption [p=.O36] and lower VAS scores at 1, 4, 5, 6, 9, 12, 15, 18, 21, and 24 hours On the other hand, on comparing K. T and S subgroups, both K and T subgroups showed a significant delay in asking for analgesic [p=.001], significantly lower pethidine consumption [p=.001] and significantly lower VAS scores at 1, 2, 3, 6, 12, 15. and 24 hours as compared to S subgroups. On comparing K and T subgroups, there was no significant difference among them except in the first 2 hours where K subgroups had significantly lower VAS in the first hour [p=.O18]. while T- subgroups showed significantly lower VAS in the second hour [p=.004]. Both ketamine and tramadol proved to be useful and safe analgesic agents when applied intra-articularly particularly in the low inflammatory procedures