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Effect of Intraarticular Ketamine after Knee Arthroscopy  

Kang, Keon (Department of Anesthesiology and Pain Management, Ulsan University Hospital, Collage of Medicine, Ulsan University)
Shin, Chul Ho (Department of Anesthesiology and Pain Management, Ulsan University Hospital, Collage of Medicine, Ulsan University)
Lee, Young Hee (Department of Anesthesiology and Pain Management, Ulsan University Hospital, Collage of Medicine, Ulsan University)
Cho, Young Woo (Department of Anesthesiology and Pain Management, Ulsan University Hospital, Collage of Medicine, Ulsan University)
Park, Soon Eun (Department of Anesthesiology and Pain Management, Ulsan University Hospital, Collage of Medicine, Ulsan University)
Son, Hee Won (Department of Anesthesiology and Pain Management, Ulsan University Hospital, Collage of Medicine, Ulsan University)
Cho, Sung Do (Departmens of Orthopedics, Ulsan University Hospital, Collage of Medicine, Ulsan University)
Park, Se Hun (Department of Anesthesiology and Pain Management, Ulsan University Hospital, Collage of Medicine, Ulsan University)
Publication Information
The Korean Journal of Pain / v.18, no.2, 2005 , pp. 198-203 More about this Journal
Abstract
Background: This study was designed to demonstrate the peripheral effect of ketamine on the synovia of the knee joint and evaluate the analgesic effect of an intraarticular ketamine injection following knee arthroscopy. Methods: In a double blind randomized study, 80 ASA class 1 or 2 patients were selected for elective arthroscopic knee surgery. The patients received either 20 ml of normal saline (Group C, n = 19), 20 ml of 0.5% ropivacaine (Group R, n = 21), 1 mg/kg of ketamine mixed with 20 ml of normal saline (Group K, n = 20) or 1 mg/kg of ketamine mixed with 20 ml of 0.5% ropivacaine (Group RK, n = 20), intraarticularly, just prior to wound closure. Postoperative pain was evaluated using a visual analogue scale (VAS 0 to 100) score at 1, 2, 6, 12, 24 and 48 hours after the intraarticular injection, with the side effects found in the four groups also evaluated. The patients' requests for rescue analgesic were recorded, total doses of tarasyn calculated and the overall patient satisfaction also evaluated. Results: The difference in the VAS scores for all time periods was not significant. The number of patients receiving rescue analgesics and the total doses received in Group C were greater than those for the other groups, but this was not significant. No side effects were observed in any of the patients. Conclusions: Ketamine and local anesthetics have been reported to have peripheral analgesic effects, with variable duration in the measurements of pain and hyperalgesia. However, we failed to demonstrate a peripheral analgesic effect on postoperative arthroscopic pain.
Keywords
arthroscopy; intraarticular injection; ketamine; peripheral analgesic effect; ropivacaine;
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  • Reference
1 Dodds RDA, McMeniman P], Krippner R, Myers PT: Comparison of intravenous pethidine infusion with '3 in l ' lumbar plexus block after anterior cruciate ligament reconstruction. Knee 1995; 2: 43-6.
2 Stein C, Comiset K, Haimerl E, Yassouridis A, Lehberger K, Herz A, et al: Analgesic effecrs of intraarticular morphine after arthroscopic knee surgery. N Eng] Med 1991; 325: 1123-6.
3 Khoury FG, Chen ACN, Garland DE, Stein C: Intraarticular morphine, bupivacaine and morphine/bupivacaine for pain control after knee videoarthroscopy. Anestesiology 1992; 77: 263-6.
4 Kohrs R, Durieux ME: Keramine: teaching an old drug new tricks. Anesth Analg 1998; 87: 1186-93.
5 Tverskoy M, Oz Y, Isakson A, Finger ], Bradley EL ]r, Kissin I: Preemptive effect of fentanyl and ketamine on postoperative pain and wound hyperalgesia. Anesth Analg 1994; 78: 205-9.
6 De Negri P, Ivani G, De Vivo P: How to prolong postoperative analgesia after caudal anesthesia with ropivacaine in children: Sketarnine versus c1onidine. Paediatr Anaesth 2001; 11: 679-83.
7 Durrani Z, Winnie AP, Elemer KZ, Burnet ML: Kcramine for intravenous regional anesthesia. Anesth Analg 1989; 68: 328-33.
8 Oh IY, Park CS, Kim TY, Kim IK, Shin MK, Lee SY: Analgesic effects of addition of neostigmine or morphine into intraarticular bupivacaine in simple arthroscopic knee surgery. Korean] Anesthesiol 2002; 43: 85-92.
9 Dalsgaard], felsby S, ]uelsgaard P, Froekjaer]: Low-dose intraarticular morphine analgesia in day case knee arthroscopy: a randomized double- blinded prospecrive study. Pain 1994; 56: 151-4.
10 Drosos GI, Vlachonikolis IG, Papoursidakis AN, Gavalas NS, Anthopoulos G: Intra-articular morphine and postoperative analgesia after knee arthroscopy. Knee 2002; 9: 335-40.
11 Kaeding CC, Hill ]A, Katz ], Benson L: Bupivacaine use after knee arthroscopy: pharmacokinetics and pain control study. Arthroscopy 1990; 6: 33-9.
12 Allen GC, St. Amand MA, Lui ACP, ]ohnsson DH, Lindsay P: Postarthroscopyanalgesia with intraarticular bupivascaine/morphine. Anesthesiology 1993; 79: 475-80.
13 Wang J], Ho ST, Lee SSH, Tang J], Liaw W]: Intraarticular triamcinolone acetate for pain control after arthroscopic knee surgery. Anesrh Analg 1998; 87: 1113-6.
14 Yang LC, Chen L, Wang C, Buerkle H: Postoperative analgesia by intra-articular neostigmine in patients undergoing knee arthroscopy. Anesthesiology 1998; 88: 334-9.
15 Hood DD, Eisenach ]C, Turtle R: Phase I safery assessment of intrathecal neosrigmine methylsulfate in humans. Anesthesiology 1995; 82: 331-43.
16 Kizilkaya M, Yildirim OS, Dogan N, Kursad H, Okur A: Analgesic effects of intraarticular sufentanil and sufentanil plus methylprednisolone after artroscopic knee surgery. Anesrh Analg 2004; 98: 1062-5.
17 Toivonen ], Pitko VM, Rosenberg PH: Comparison between intraarticular bupivacaine with epinephtine and epinephrine alone on short-term and long-term pain after knee arthroscopic surgery under general anesthesia in day-surgery parients. Acta Anesthesiol Scand 2002; 46: 435-40.
18 Reckziegel G, Friederich P, Urban BW: Ketamine effects on human neuronal Na + channels. Eur ] anaesth 2002; 19: 634-40.
19 Moinche S, Mikkelson S, Wetterslev ], Dahr ]B: A systematic review of intra-articular local anesthesia for postoperative pain relief after arthroscopic knee surgery. Reg Anesrh Pain Med 1999; 24: 430-7.
20 Carlton SM, Hargert GL, Coggeshall RE: Localization and activation of glutamate receptors in unmyelinated axons of rat glagorous skin. Neurosci Letr 1995; 197: 25-8.
21 Raja S, Dickstein RE, ]honson CA: Comparison of postoperative analgesic effects of intraarticular bupivacaine and morphine following artroscopic knee surgery. Anesthesiology 1992; 77: 1143-7.
22 Aasb0 V, Rieder ]C, Grngaard B, R0ise 0: No addirional analgesic effect of intra-articular morphine or bupivacaine compared with placebo after elective knee arthroscopy. Acta Anaesthesiol Scand 1996; 40: 585-8.
23 Talu GK, Ozyal<;:in S, Kolrka K, Erturk, E, Akinci 0, A;;ik M, et al: Comparison of efficacy of intraarticular application of tenoxicam, bupivacaine and tenoxicam: bupivacaine combination in arthroscopic knee surgery. Knee Surg Sports Traumatol Trrhrosc 2002; 10: 355-60.
24 Tverskoy M, Oren M, Vaskovich M, Dashkovsky I, Kissin I: Ketamine enhances local anesthetic and analgesic effects of bupivaciane by peripheral mechanism: a study in postoperative patients. Neurosci Lett 1996; 215: 5-8.
25 Warncke T, ]0rum E, Stubhaug A: Local treatment with the Nmethyl-D-aspartate receptor antagonist ketamine, inhibit development of secondary hyperalgesia in man by a peripheral action. Neurosci Lett 1997; 227: 1-4.
26 Reuben SS, Connelly NR: Postoperative analgesia for outpatient arthroscopic knee surgery with intraarticular clonidine. Anesth Analg 1999; 88: 729-33.   DOI
27 Kim ]B, Shin YS: The comparison of postoperarive analgesic effect of morphine-bupivacaine and morphine-bupivacaine-c1onidine injected inrraarricularly after knee arthroscopy. Korean] Anesthesiol 2001; 41: 52-8.
28 Chirwa 55, MacLeod BA, Day B: Intraarticular bupivacaine (marcaine) after arthroscopic meniscectomy: A randomized double-blind controlled srudy. Arthroscopy 1989; 5: 33-5.
29 Howe ]R, Wang ]Y, Yaksh TL: Selective antagonism of the antinociceprive effect of intrarhecally applied a2-adrenergic agonist by intrarhecal prazocine and intrathecal yohimbine. ] pharmcol Exp Ther 1983; 224: 552-8.