Reflex inhibition of the quadriceps after meniscectomy: lack of association with pain

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Abstract
Summary. We have examined the severity and duration of reflex inhibition of quadriceps activation after arthrotomy and meniscectomy, its relationship with pain, and the effect of local anaesthesia on this relationship. Fourteen men, on completion of medial meniscectomy by arthrotomy, received either 10 ml (BIO group) or 15 ml (B15 group) of 0–5% bupivacaine hydrochloride (‘Marcaine Plain’) into the knee, or no injection (control group). Reflex inhibition of quadriceps was measured as the percentage reduction, from the ipsilateral preoperative value, in the integrated surface electromyogram recorded during maximal voluntary isometric contractions with the knee in extension. Pain during each contraction was recorded on a linear analogue scale. Unoperated limbs showed no evidence of quadriceps inhibition. In the operated limbs, at 1–2 h post-operatively, controls had both severe inhibition (median = 62%) and severe pain on attempting a maximal quadriceps contraction. The BIO group had similar inhibition but less pain (P= s 0–005, Wilcoxon 2-sample, 1-tailed test). In the B15 group both inhibition (P 0–05) and pain (P 0–01) were less than in the controls. These effects of bupivacaine had been lost by 4–5 h post-operatively. At 3–4 days, inhibition was still severe (median=75%) in all three groups of patients but pain was only mild or absent. At 10–15 days, median inhibition was still 35%, but there was little or no pain. We conclude that postmeniscectomy inhibition is not simply due to perceived pain but is due, at least in part, to stimuli from the knee.