Postoperative Analgesia for Outpatient Arthroscopic Knee Surgery with Intraarticular Bupivacaine and Ketorolac

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Abstract
Intraarticular (IA) local anesthetics are often used for the management and prevention of pain after arthroscopic knee surgery. Systemic ketorolac is also useful in the management of these patients. Ketorolac, a nonsteroidal antiinflammatory drug (NSAID), alters the sensitivity of peripheral nociceptors by reducing the local concentration of allogenic chemicals which are activated by peripheral tissue injury. It is interesting to speculate that placing a NSAID at the site of injury might result in more profound pain relief. However, IA ketorolac has not been evaluated in arthroscopic patients. This study thus was designed to determine which regimen would result in the most effective analgesic benefit. The four groups evaluated received ketorolac (either via the parenteral or IA route) or saline placebo with or without IA bupivacaine, as follows: Group 1 received IA bupivacaine; Group 2, intravenous ketorolac and IA bupivacaine; Group 3, IA bupivacaine with ketorolac; and Group 4, IA ketorolac. The results of this study revealed a significant difference in analgesia from the IA administration of ketorolac. The group who received a combination of IA bupivacaine and IA ketorolac had decreased postoperative pain, a decreased need for postoperative analgesics, and an increased analgesic duration. We conclude that the use of IA ketorolac improved comfort in patients undergoing knee arthroscopy.