Preemptive oral rofecoxib plus postoperative intraarticular bupivacaine for pain relief after arthroscopic knee surgery.

Bu cal›flmada, preemptif oral rofekoksibin, artroskopik diz cerrahisi sonras› intraartikuler bupivakain analjezisine etkisi araflt›r›ld›. Altm›fliki olgu uc gruba ayr›ld›. Grup 1'e (n=21) ameliyattan 1 saat once oral 50 mg rofekoksib ve ameliyattan sonra intraartikuler 20 ml % 0.5 bupivakain, Grup 2'ye (n=21) ayn› dozda bupivakain ve Grup 3'e (n=20) ameliyat sonras› intraartikuler 20 ml salin uyguland›. Ar› skorlar› postoperatif 30. dak., 1, 2, 4, 6, 12 ve 24. saatlerde VAS ile deerlendirildi. Analjezi suresi, analjezik (tramadol, tenoksikam) gereksinimleri ve yan etkiler kaydedildi. Ar› skorlar› cerrahiden sonra Grup 3'le karfl›laflt›r›ld›¤›nda Grup 1'de tum zaman noktalar›nda (p<0.05, p<0.001), Grup 2'de 30. dak (p<0.001), 1. ve 4. saatlerde (p<0.05) daha dufluktu. Grup 1'de ise Grup 2'den ilk 4 saatte daha dufluktu (p<0.05, p<0.001). Analjezi suresi Grup 1'de Grup 2 ve 3'den (743.0 ± 480.5 dk vs. 262.4 ± 292.2 dk ve 17.0 ± 12.1 dk; p<0.05, p<0.001); Grup 2'de Grup 3'ten belirgin (p<0.05) olarak daha uzundu. Tramadol gereksinimleri Grup 1'de Grup 2 ve 3'den (4.8 ± 15.0 mg vs. 40.5 ± 43.6 mg ve 67.5 ± 24.5 mg; p<0.05, p<0.001); Grup 2'de Grup 3'ten anlaml› (p<0.05) olarak daha azd›. Tenoksikam gereksinimleri ve yan etkiler gruplar aras›nda farks›zd›. Sonuc olarak, preemptif oral rofekoksib ve postoperatif intraartikuler bupivakainin kombine kullan›m›n›n artroskopik diz cerrahisi sonras› belirgin analjezik fayda ve opioid gereksiniminde azalma salad›¤› kan›s›na var›ld›. Anahtar kelimeler: Preemptif, rofekoksib, bupivakain, postoperatif analjezi, artroskopik diz cerrahisi SUMMARY This study was designed to test the hypothesis whether preemptive administration of rofecoxib, a novel selective COX-2 inhibitor, can prolong intraarticular bupivacaine analgesia after arthroscopic knee surgery. Sixty-two patients were randomly assigned to one of the three groups. Group 1 (n=21) was administered oral rofecoxib 50 mg 1 h before surgery plus intraarticular 0.5 % bupivacaine 20 ml postoperatively. Group 2 (n=21) was administered the same dose of bupivacaine. Group 3 (n=20) was administered saline 20 ml intraarticularly after surgery. Pain scores (VAS) were assessed at 30 min, 1, 2, 4, 6, 12 and 24 h postoperatively. Analgesia duration, analgesic (tramadol and tenoxicam) requirements, and adverse effects were recorded postoperatively for 24 h. Pain scores were significantly lower in the Group 1 at all time points (p<0.05, p<0.001) and were significantly lower in the Group 2 at 30 min (p<0.001), 1 and 4 h (p<0.05) compared to the Group 3. Pain scores were significantly lower in the Group 1 compared to the Group 2 during the first 4 h after surgery (p<0.05, p<0.001). Analgesia duration was longer in Group 1 than Group 2 or 3 (743.0 ± 480.5 min versus 262.4 ± 292.2 min and 17.0 ± 12.1 min; p<0.05, p<0.001 respectively), and in Group 2 than Group 3 (p<0.05). Tramadol requirements were significantly less in Group 1 than Group 2 and 3 (4.8 ± 15.0 mg versus 40.5 ± 43.6 mg and 67.5 ± 24.5 mg; p<0.05, p<0.001 respectively), and in Group 2 than Group 3 (p<0.05). There were no significant differences among the groups regarding the tenoxicam requirements and adverse effects. In conclusion, the combination of oral rofecoxib administered preemptively and intraarticular bupivacaine administered postoperatively provided a significant analgesic benefit and decreased the opioid require- ments after arthroscopic knee surgery, when compared to bupivacaine alone or saline.