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ORIGINAL ARTICLE
Year : 2020  |  Volume : 4  |  Issue : 2  |  Page : 113-117

Intra-articular ultra-low-dose naloxone for postoperative analgesia after knee arthroscopy


Department of Anesthesia and Intensive Care, Al-Azhar Faculty of Medicine, Cairo, Egypt

Correspondence Address:
MD Usama I Abotaleb
214, Faisal Street, Alharam, Giza, 12555
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjamf.sjamf_5_20

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Background Naloxone has been used at low doses to enhance the analgesic effect; however, this application remains less well defined. It was added to local anesthetics for intrapleural, axillary brachial plexus block, and peribulbar anesthesia with good results but was not used before as an adjuvant in intra-articular injection. The aim of this prospective double-blinded randomized controlled study is to assess the effect of intra-articular ultra-low-dose naloxone when added to bupivacaine on postoperative pain after knee arthroscopy, with time to first analgesic request as the primary outcome and total analgesic requirement, severity of pain, and side effects as secondary outcomes. Patients and methods In all, 80 patients who underwent knee arthroscopic meniscectomy under general anesthesia were randomly allocated into two groups (40 patients each): the naloxone group received 100 ng naloxone added to 20 ml 0.25% bupivacaine, and the control group received 20 ml 0.25% bupivacaine. General anesthesia was standardized for all patients. At the end of surgery, the study solution was injected intra-articularly through the arthroscope. Visual analog scale was recorded at 1, 2, 4, 6, 8, 12, 18, and 24 h. An intravenous dose of 20 mg pethidine was given if visual analog scale greater than or equal to 3 or on patient request. The time to first analgesic request, total analgesic consumption, and side effects were recorded. Results The time to first analgesic request was significantly longer, and the total analgesic consumption was significantly lower in the naloxone group compared with the control group. Pain score was significantly higher after 6 and 8 h in the control group compared with the naloxone group. No side effects were reported. Conclusion Intra-articular ultra-low-dose naloxone enhanced postoperative analgesic effect of bupivacaine after knee arthroscopy without adverse effects.


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