Intra-articular Bupivacaine versus Bupivacaine plus Dexamethasone for Analgesia after Knee Surgery

Background: Postoperative pain is a common problem suffering the patients after knee surgery. Treatment with intra- articular corticosteroid preparation has been advocated but the value of this approach has not been established. We compared the efficacy of intra-articular dexamethasone plus bupivacaine with the efficacy of intra-articular bupivacaine alone to prevent post-operative pain after meniscectomy. Methods: sixty ASAI patients undergoing meniscectomy with general anesthesia were randomly assigned to receive intra-operative intra-articular bupivacaine, bupivacaine plus dexamethasone , or placebo under double blinded condition.the group 1 (n=20) received 10ml of bupivacaine 0.5% with epinephrine 1:2000000, group 2 (n=20) received 8ml dexamethasone and group 3 (n=20) received 10ml of normal saline. The patients were evaluated until 12 hours after the operation and pain levels at rest measured by a Visual Analogue Scales(VAS) Results: during the firs six hours after the operation, both combination of bupivacaine and dexamethasone and bupivacaine alone significantly reduced patient's pain (p=0.000) and during six to twelve hours after operation the patients in dexamethasone group had significantly lower pain scores comparing to other group (P=0.037).the low pain scores were associated with lower requirement of supplementary analgesics (p=0.000). Conclusion: combination of intra-articular dexamethasone and bupivacaine significantly reduces post-operative pain and consumption of analgesics following meniscectomy than intra-articular bupivacaine alobe. Keywords: intra-articular,bupivacaine,dexamethasone,post-articular operative pain.