Effects of intraarticular tramadol, magnesium and ketamine on postoperative pain in arthroscopic meniscectomy

Salman, Nevriye; Olgunkeleş, Bilge; Bektaş, Umut; Güner, Derviş; Bektas, Meltem; Ay, Şadan; Şekerci, Sumru

doi:10.1016/j.bjane.2018.09.002

Abstract

Objective:

Postoperative pain control is important in terms of early recovery and rehabilitation in arthroscopic meniscectomy. For this purpose, we aimed to compare the effects of intraarticular tramadol, magnesium, and ketamine with combinations of pericapsular bupivacaine on postoperative pain and recovery in arthroscopic meniscectomy.

Methods:

Ninety patients who underwent arthroscopic meniscectomy were enrolled in the study. Group T was given tramadol, Group K was given ketamine, and Group M was given magnesium reconstituted intraarticularly, and all groups received periarticular bupivacaine. Comparisons were made in terms of the patients' postoperative Visual Analogue Scale scores with and without movement, need for additional analgesics, first analgesic time, mobilization times, adverse effects, and satisfaction with the analgesics.

Results:

The Visual Analogue Scale scores were lowest in Group T at 0 minutes, and were higher in the 15th and 30th minutes and 1st, 2nd, and 6th hours. Visual Analogue Scale values with movement were found to be high in Group M at 0 and 15 minutes, but they were found to be higher in group T in the 30th minute, 1st, 2nd and 6th hour. The groups were similar in terms of postoperative additional analgesic use, number of analgesic use, and satisfaction with analgesics; however, the first analgesic time was earlier in Group M, and the first mobilization time was earlier in Group K.

Conclusion:

Intraarticular ketamine enables early mobilization and less need for additional analgesics, it also provides a better analgesic effect in comparison with intraarticular tramadol and magnesium.

KEYWORDS
Intraarticular analgesia; Ketamine; Tramadol; Magnesium; Knee arthroscopy

[1] * Corresponding author. E-mail:nevriyes@hotmail.com (N. Salman).

	Group K (n = 30)	Group T (n = 30)	Group M (n = 30)	p
Sex (F/M), n	12/18	12/18	12/18	0.999
Age (years) mean ± SD	45.7 ± 12.1	45.2 ± 14.1	43.0 ± 10.5	0.679
BMI (kg.m⁻²) mean ± SD	27.8 ± 5.8	28.9 ± 5.7	28.9 ± 5.7	0.161
ASA (I/II), n	23/7	22/8	18/12	0.329

	Group K (n = 30)	Group T (n = 30)	Group M (n = 30)
Anesthesia duration (min), mean ± SD	52.0 ± 12.8	48.7 ± 13.3	51.7 ± 8.9
Surgery duration (min), mean ± SD	34.7 ± 8.4	30.6 ± 9.8	33.3 ± 2
Total crystalloid given (mL), mean ± SD	401.7 ± 122.8	397.3 ± 217.4	340.7 ± 106.2

	Group K (n = 30)	Group T (n = 30)	Group M (n = 30)
VAS with movement 0th min, mean ± SD	0.1 ± 0.3^b b p < 0.05, when compared with Group M.	0.6 ± 1.7^b b p < 0.05, when compared with Group M.	5.2 ± 3.2
VAS with movement 15th min, mean ± SD	0.3 ± 1.6^a a p < 0.05, when compared with Group T.	3.9 ± 3.9	4.8 ± 3.2^c c p < 0.05, when compared with Group K.
VAS with movement 30th min, mean ± SD	0.8 ± 2.1^a a p < 0.05, when compared with Group T.	4.0 ± 3.4	1.7 ± 2.0^a a p < 0.05, when compared with Group T.
VAS with movement 1st hr, mean ± SD	1.1 ± 2.2^a a p < 0.05, when compared with Group T.	3.4 ± 2.9	0.1 ± 0.6^a a p < 0.05, when compared with Group T.
VAS with movement 2nd hr, mean ± SD	0.6 ± 1.3^a a p < 0.05, when compared with Group T.	2.6 ± 2.8	0^a a p < 0.05, when compared with Group T.
VAS with movement 6th hr, mean ± SD	0.3 ± 1.2^b b p < 0.05, when compared with Group M.	1.9 ± 2.3^b b p < 0.05, when compared with Group M.	0
VAS without movement 0th min, mean ± SD	0.0 ± 1.2^b b p < 0.05, when compared with Group M. ^,^a a p < 0.05, when compared with Group T.	0.0 ± 0.4^b b p < 0.05, when compared with Group M.	4.5 ± 3.1
VAS without movement 15th min, mean ± SD	0.3 ± 1.6	2.8 ± 3.4^c c p < 0.05, when compared with Group K.	4.2 ± 2.8^c c p < 0.05, when compared with Group K.
VAS without movement 30th min, mean ± SD	0.5 ± 1.6^a a p < 0.05, when compared with Group T.	3.0 ± 3.3	1.6 ± 2.6^a a p < 0.05, when compared with Group T.
VAS without movement 1st hr, mean ± SD	0.6 ± 1.6^a a p < 0.05, when compared with Group T.	2.3 ± 2.6	0.2 ± 0.9^a a p < 0.05, when compared with Group T.
VAS without movement 2nd hr, mean ± SD	0.4 ± 1.0^a a p < 0.05, when compared with Group T.	1.5 ± 1.9	0^a a p < 0.05, when compared with Group T.
VAS without movement 6th hr, mean ± SD	0.4 ± 1.4	1.0 ± 1.7	0^a a p < 0.05, when compared with Group T.

	Group K (n = 30)	Group T (n = 30)	Group M (n = 30)
Nausea 0th, n (%)	0 (0)	1 (100)	0 (0)
Nausea 15th min, n (%)	1 (50)	1 (50)	0 (0)
Nausea 30th min, n (%)	2 (40)	3 (60)	0 (0)
Nausea 1st hr, n (%)	2 (100)	0 (0)	0 (0)
Nausea 2nd hr, n (%)	1 (50)	1 (50)	0 (0)
Nausea 6th hr, n (%)	0 (33)	0 (33)	0 (33)
Vomiting 0th min, n (%)	0 (33)	0 (33)	0 (33)
Vomiting 15th min, n (%)	1 (100)	0 (0)	0 (0)
Vomiting 30th min, n (%)	1 (100)	0 (0)	0 (0)
Vomiting 1st hr, n (%)	2 (100)	0 (0)	0 (0)
Vomiting 2nd hr, n (%)	1 (100)	0 (0)	0 (0)
Vomiting 6th hr, n (%)	0 (33)	0 (33)	0 (33)
Hallucination, n (%)	30 (100)^a a p < 0.05 with Chi-square test in three groups.	0 (0)	0 (0)

	Group K (n = 30)	Group T (n = 30)	Group M (n = 30)
Patients who used additional analgesia, n (%)	25 (31.3)	29 (36.3)	26 (32.5)
Time of first analgesic (hour), mean ± SD	3.5 ± 1.6^a a p < 0.05, when compared with Group M.	4.2 ± 1.9^a a p < 0.05, when compared with Group M.	1.9 ± 0.5
Number of additional analgesics, mean ± SD	1.5 ± 1.1	1.6 ± 0.9	1.7 ± 1.0
Patients with pain on 24th hour, n (%)	1 (33.3)	2 (66.7)	0 (0)
Satisfaction about analgesia, mean ± SD	2.4 ± 0.5	2.2 ± 0.5	2.2 ± 0.5
Time of mobilization (hour), mean ± SD	1.6 ± 0.6	1.9 ± 0.6^b b p < 0.05, when compared with Group K.	1.9 ± 0.2^b b p < 0.05, when compared with Group K.