TITLE: INTRAOPERATIVE USE OF AN INTRA-ARTICULAR PERFUSION SOLUTION DECREASES POSTOPERATIVE PAIN

AUTHORS: John G. Brock-Utne, MA, MB, BCh, MD, Michael F. Dillingham, MD, Gary S. Fanton, MD
AFFILIATION: Stanford University School of Medicine, Stanford, CA.

INTRODUCTION: The search for an effective and safe postoperative pain relief method after arthroscopic surgery is continuing. We have included in the intra-articular perfusion solution minute amounts of amitriptyline, metoclopramide and sumatriptan. These drugs were chosen because of their activity at serotonin and histamine receptors. This solution was used intraoperatively to ascertain any improved pain relief post- operatively.
METHODS: Thirty-two patients with informed consent scheduled for arthroscopic anterior cruciate ligament repair using allograft were studied. The study was a random double-blind, placebo-controlled study. During the surgery, synovial biopsies were obtained both at the beginning and the end of the procedure. In the Recovery Room, fentanyl IV was given in 25 mcg increments until the Visual Analogue Scale (VAS) was 3 or below. Statistical analysis was done using a Mann-Whitney U non-parametric test.
RESULTS: There was a statistically significant improvement in VAS pain score in the experimental group (3.3) postoperatively compared to control (5.6) (p<0.02). Similarly, the average postoperative fentanyl requirements were significantly lower in the experimental group 76 mg versus 146 mg in the control (p<0.04). No synovial abnormalities were seen.
CONCLUSION: This intra-articular perfusion solution used intraoperatively provided statistically significant improvement in postoperative pain scores and decreased fentanyl requirement.
This study was supported by Omeros Medical Systems, Inc., Seattle WA 98101.