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Papers of the Week

2022 Apr

Rev Bras Ortop (Sao Paulo)



Assessment of The Addition of Epinephrine to Intra-articular Bupivacaine for the Control of Acute Pain in Patients underwent to Anterior Cruciate Ligament Reconstruction.


de Leão M G S, Nunes J C, da Silva I T CE, Perfeito A B, de Rogério W P, Nunes R B SE
Rev Bras Ortop (Sao Paulo). 2022 Apr; 57(2):257-266.
PMID: 35652031.


 To evaluate postoperative pain, using the visual analog scale (VAS), in patients undergoing anterior cruciate ligament reconstruction (ACLR) and receiving intra-articular anesthetic solutions.  The present is a randomized clinical trial with a sample of 48 patients divided into 4 groups: Group I (n = 12) – 20 mL of saline solution (control); Group II (n = 12) – 20 mL of 0.5% bupivacaine; Group III (n = 12) – 20 mL of 0.5% bupivacaine + 0.1 mg of epinephrine; and Group IV (n = 12) – 20 mL of saline solution + 0.1 mg of epinephrine. These solutions were injected into the knee at the end of the surgery. Pain was assessed using the VAS immediately and 6, 12, 24 and 48 hours after the procedure.  The VAS scores were highly variable among the groups. A Kruskal-Wallis analysis of variance (ANOVA), considering a level of significance of 5%, revealed that all intra-articular anesthetic solutions influenced the assessment of pain (  = 0.003), and that Group-III subjects presented less postoperative pain. There was no evidence of a higher or lower use of supplemental analgesic agents, or of adverse effects resulting from these anesthetic solutions.  Bupivacaine combined with epinephrine was the most effective solution for pain control in patients undergoing ACLR, but with no statistically significant differences when compared to Group II (  = 0.547). There was no decrease or increase in the use of supplemental analgesics or in the occurrence of adverse systemic effects (  > 0.05).