Assessment of The Addition of Epinephrine to Intra-articular Bupivacaine for the Control of Acute Pain in Patients underwent to Anterior Cruciate Ligament Reconstruction

Marcos George de Souza Leão; Juscimar Carneiro Nunes; Ivan Tramujas da Costa E Silva; Alan Braga Perfeito; Wagner de Paula Rogério; Rafaela Brasil E Silva Nunes

doi:10.1055/s-0040-1718514

Assessment of The Addition of Epinephrine to Intra-articular Bupivacaine for the Control of Acute Pain in Patients underwent to Anterior Cruciate Ligament Reconstruction

Rev Bras Ortop (Sao Paulo). 2021 Apr 19;57(2):257-266. doi: 10.1055/s-0040-1718514. eCollection 2022 Apr.

Authors

Marcos George de Souza Leão¹, Juscimar Carneiro Nunes², Ivan Tramujas da Costa E Silva², Alan Braga Perfeito¹, Wagner de Paula Rogério³, Rafaela Brasil E Silva Nunes³

Affiliations

¹ Departamento de Ortopedia e Traumatologia, Fundação Hospital Adriano Jorge, Manaus, AM, Brasil.
² Programa de Pós-Graduação em Cirurgia, Universidade Federal do Amazonas, Manaus, AM, Brasil.
³ Serviço de Anestesiologia, Fundação Hospital Adriano Jorge, Manaus, AM, Brasil.

Abstract

Objective To evaluate postoperative pain, using the visual analog scale (VAS), in patients undergoing anterior cruciate ligament reconstruction (ACLR) and receiving intra-articular anesthetic solutions. Methods The present is a randomized clinical trial with a sample of 48 patients divided into 4 groups: Group I (n = 12) - 20 mL of saline solution (control); Group II (n = 12) - 20 mL of 0.5% bupivacaine; Group III (n = 12) - 20 mL of 0.5% bupivacaine + 0.1 mg of epinephrine; and Group IV (n = 12) - 20 mL of saline solution + 0.1 mg of epinephrine. These solutions were injected into the knee at the end of the surgery. Pain was assessed using the VAS immediately and 6, 12, 24 and 48 hours after the procedure. Results The VAS scores were highly variable among the groups. A Kruskal-Wallis analysis of variance (ANOVA), considering a level of significance of 5%, revealed that all intra-articular anesthetic solutions influenced the assessment of pain ( p = 0.003), and that Group-III subjects presented less postoperative pain. There was no evidence of a higher or lower use of supplemental analgesic agents, or of adverse effects resulting from these anesthetic solutions. Conclusion Bupivacaine combined with epinephrine was the most effective solution for pain control in patients undergoing ACLR, but with no statistically significant differences when compared to Group II ( p = 0.547). There was no decrease or increase in the use of supplemental analgesics or in the occurrence of adverse systemic effects ( p > 0.05).

Keywords: analgesia; anterior cruciate ligament; arthroscopy; drug therapy; pain assessment.

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