Effects of intra-articular levobupivacaine, fentanyllevobupivacaine and tramadol-levobupivacaine for postoperative pain in arthroscopic knee surgery

Objective: The aim of this study was to compare the postoperative analgesic efficacy of intra-articu- larly injected levobupivacaine, levobupivacaine-fentanyl, and levobupivacaine-tramadol combinations. Methods: Eighty patients scheduled for elective knee arthroscopy were divided randomly into 4 groups of 20 patients each. Group 1 (the control group) received intra-articular saline, Group 2 received le- vobupivacaine 2.5 mg/ml, Group 3 received levobupivacaine 2.5 mg/ml + tramadol 50 mg, and Group 4 received levobupivacaine 2.5 mg/ml + fentanyl l50 mcg. All patients were operated on under general anesthesia, and a total of 20 ml study solution was injected: 7 ml subcutaneously before surgery and 13 ml intra-articularly upon completion of surgery. For postoperative, pain visual analogue scale (VAS) was assessed at the 1^st, 2^nd, 4^th, 8^th, 12^th, and 24^th hours postoperatively. Patients with a VAS score over 5 received diclofenac sodium, and the need for rescue analgesics was recorded. Results: At the 1^st, 2^nd, 4^th, 8^th, 12^th, and 24^th postoperative hours, Group 3 and Group 4 had statisti- cally significant lower VAS scores of pain (p 0.01). Postoperative rescue analgesic requirements were different among the groups. The postoperative 1^st hour analgesic requirement was statistically signifi- cantly lower in Group 3 and Group 4 when compared to the other groups (p 0.01). At the postopera- tive 2^nd and 4^th hours, analgesic requirements were statistically significantly lower in Group 3 than in the other groups (p 0.01). Analgesic requirements were statistically significantly lower in Group 3 and Group 4 than in the other groups (p 0.01). Analgesic requirements at the 12^th and 24^th postopera- tive hours did not show any statistically significant difference (p 0.05). Conclusion: The results indicated that levobupivacaine combined with either fentanyl or tramadol decreased rescue analgesic requirements when compared to levobupivacaine alone.