Analgesic Control Following Knee Arthroscopy

Analgesic Control Following Knee Arthroscopy: Results of a Randomised , Double-blinded Trial Comparing a Hyaluronic Acid Supplement to Bupivacaine

This study aims to investigate the analgesic effects offered by bupivacaine and Durolane (a hyaluronic acid supplement) administered immediately following the completion of knee arthroscopy.

There is increasing evidence of the toxic effects of intraarticular administration of local anaesthetic. Hyaluronic acid supplementation given at the time of knee arthroscopy has not been fully evaluated as a possible alternative. We have studied the efficacy of a hyaluronic acid (HA) supplement (Durolane®) and a local anaesthetic (Bupivacaine) at providing early and short-term post-operative analgesic control following knee arthroscopy.Patients will be randomised to receive either 10mls of 0.5% Bupivacaine or 10mls of Durolane® into the joint immediately after completion of surgery. WOMAC and Tegner-Lysholm scores were obtained at baseline then at 1, 2, and 6-weeks post surgery. VAS pain scores were obtained at baseline; 1 and 24-hours; and 1, 2 and 6 weeks following surgery.

Inclusion Criteria:

• those undergoing knee arthroscopy for: diagnostic purposes, removal of loose bodies, articular cartilage debridement or, meniscectomy
• age over 18 years

Exclusion Criteria:

• American Society of Anaesthesiologists (ASA) grade ≥3;
• arthroscopic assisted osteotomies;
• a history of two or more prior procedures on the ipsilateral knee;
• post-operative morbidities indirectly linked to the procedure (e.g. anaesthetic complications, DVT or PE);
• systemic steroid requirements;
• previous intra-articular anaesthetic or steroid injection within the last three months;
• intra-articular HA injection within the last nine months;
• intra-articular sepsis within the previous three months;
• prior history of knee arthroplasty, peri-articular fracture, ligamentous instability, inflammatory arthritis or a previous diagnosis of Complex Regional Pain Syndrome.