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International Journal of Recent Trends in Science and Technology, ISSN 2277-2812 E-ISSN: 2249-8109
Volume 16, Issue 2, Sept 2015 pp 374-380
Comparison of analgesic effect of intraarticular buprenorphine, fentanyl and morphine following arthroscopic surgery of knee
Shashidhar G S*, Rashmi N R**, Sumitha C S***, Suresh Chengode****
*,**, ***Assistant Professor, Department of Anaesthesia and Pain Relief, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, INDIA.
****Professor, Department of Anaesthesia, Amritha Institute of Medical Sciences, Kochi, Tamil Nadu, INDIA.
Background and Aims: Pain after orthopaedic surgery depends on the site and extent of surgery and the preoperative use of analgesics by the patient. Arthroscopic procedures are routinely performed on outpatient basis and have spared patients large incisions and decreased morbidity compared with open incisions but has not eliminated pain. At present several techniques are available to treat pain following arthroscopic surgeries; these include the use of opioids (providing either peripherally or centrally mediated analgesia), local anaesthetics, non-steroidal anti-inflammatory drugs, corticosteroids, clonidine and cryotherapy. Here we sought to compare the analgesic effect of intra-articular administration of morphine, fentanyl, buprenorphine and placebo following arthroscopic surgery of knee. Methods: A prospective, randomised, placebo controlled, double blind comparative study conducted in 80 patients of either sex, who underwent arthroscopic surgery of knee, between the age group of 18 and 65 years and of ASA class I and II physical status were included in the study. pts were randomly assigned equally to one of the 4 groups of 20 each by a sealed envelope method. The groups were Group A: Patients receiving IA Buprenorphine 100mcg in 20 ml normal saline. Group B- Patients receiving IA Fentanyl 50mcg in 20 ml normal saline. Group C- Patients receiving IA Morphine 3mg in 20 ml normal saline. Group D- Patients receiving IA 20 ml normal saline as placebo. parameters monitored were degree of analgesia along with hemodynamic parameters and side effects. data were analysed using student’s t-test for continuous variables and Chi-Square test was used to find out the association between categorical variables. Results: We found that 100mcg buprenorphine or 0.5% bupivacaine when injected intra-articularly produced good and comparable postoperative pain control and reduced supplementary analgesic requirement when compared to the groups. Conclusion: Intra-articular buprenorphine and fentanyl provided effective post-operative pain relief and reduced rescue analgesic requirement in the first 8 hours following arthroscopic knee procedures. It also revealed that buprenorphine and fentanyl are better intra-articular analgesics than morphine. While intra-articular morphine was found to provide good pain relief during early post-operative period, it lacked analgesic efficacy in the latter half of our observation period.