Intraarticular analgesia after arthroscopic knee surgery: comparison of neostigmine, clonidine, tenoxicam, morphine and bupivacaine.

We conducted a randomized, placebo-controlled, double blinded study to compare the analgesic effects of intraarticular neostigmine, morphine, tenoxicam, clonidine and bupivacaine in 150 patients undergoing arthroscopic knee surgery. General anaesthesia protocol was same in all patients. At the end of the surgical procedure, patients were randomized into six intraarticular groups equally. Group N received 500 mug neostigmine, Group M received 2 mg morphine, Group T received 20 mg tenoxicam, Group C received 1 microg kg(-1) clonidine, Group B received 100 mg bupivacaine and Group S received saline 20 ml. Visual analog scale scores 0, 30 and 60 min and 2, 4, 6, 12, 24, 48 and 72 h, time to first analgesic need, analgesic consumption at 48 h and 72 h and side effects were noted. Demographic and operational parameters were similar in six groups. All study groups provided analgesia when compared with saline group (P<0.05). Duration of analgesia in Group N and C was longer than other groups (P<0.001). Analgesic consumptions of Group N, C and T were lower than other groups (P<0.01). Pain scores during 2 h postoperatively were lower in all study groups than the control group (P<0.001). In Group B, median pain scores were higher than Groups N and C at 0 min and 30 min postoperatively (P<0.001). Side effects were not significantly different among the six groups. We conclude that the most effective drugs that are administered intraarticularly are neostigmine and clonidine among the five drugs we studied. Tenoxicam provided longer analgesia when compared with morphine and bupivacaine, postoperatively.

The use of intraarticular tramadol for postoperative analgesia after arthroscopic knee surgery: a comparison of different intraarticular and intravenous doses.

We aimed to determine the optimal dose of tramadol when administered intraarticularly after arthroscopic knee surgery under general anesthesia in patients with an American Society of Anesthesiologists (ASA) physical status score of I-II. When the surgical procedure was completed, patients were assigned to one of seven groups ( n=30 for each) in a double-blinded and randomized manner according to a table of random numbers. Group I received 100 mg tramadol, Group II received 50 mg tramadol, Group III received 20 mg tramadol and Group IV received 0.9% NaCl intraarticularly in 20 ml solutions. Group V received 100 mg tramadol, Group VI received 50 mg tramadol and Group VII received 20 mg tramadol intravenously. Pain was evaluated by using the Visual Analogue Scale (VAS) at 0 min (when the patient was cooperated after extubation), 30 min, 1 h, 4 h, 6 h, 12 h, 18 h and 24 h postoperatively. Patients were administered diclofenac sodium 75 mg intravenously (i.m.) when they experienced pain. The intraarticular tramadol groups had longer duration of analgesia than i.v. tramadol groups who were administered the same doses (I vs V; II vs VI; III vs VII; p <0.001). Group I had the longest duration of analgesia ( p<0.001). Group II had a longer time to the first analgesic request than all other groups ( p<0.001) except Group I. Consequently, Group I and II needed less analgesics than other groups ( p<0.001). Pain scores were 0-3 on the VAS in Groups I, II and V at first assessment, in Groups I and II at 30 min and 1 h, and in Group I at 4 h and 6 h postoperatively ( p<0.01). In Group V, vomiting was more a more frequent complication than with other groups ( p<0.05). It is concluded that tramadol provides analgesia with a peripheral mechanism when administered intraarticularly. The side effects of intraarticular 100 mg tramadol were no more severe than those for intraarticular 50 mg tramadol. Moreover, intraarticular 100 mg tramadol provided excellent analgesia after arthroscopic surgery.

Avulsion fractures of both anterior and posterior cruciate ligament tibial insertions.

Ipsilateral femur fracture, patellar fracture, and tibial avulsion fractures of anterior and posterior cruciate ligament injuries are reported. We know of no other report of an injury such as this in the literature. We sutured the tibial avulsion fractures by transtibial suturing technique and internally fixated the femur by intramedullary interlocking nailing 2 weeks after the trauma. After 1 year the results were evaluated as very good. Early surgical repair is valuable in these injuries.

Arthroscopic mediopatellar plicaectomy and lateral retinacular release in mechanical patellofemoral disorders.

Arthroscopy was performed on 168 knees of 164 patients with anterior knee pain by a single arthroscopic surgeon between April 1993 and March 2000, with a mean follow-up of29 months. There were 168 mediopatellar plicae, 16 infrapatellar plicae, 8 suprapatellar plicae, and 30 lateral plicae, and all plicae were excised. Lateral retinacular release was performed in 74 patients with patellar lateral compression syndrome, patellar lateralization, and patellar lateral subluxation through anterolateral portal without using a third portal with the help of a hook knife. Débridement and drilling were performed in type 3 and 4 chondropathies (Outerbridge classification), and cartilage débridement was performed in type 2 chondropathies. We examined the effect on morbidity and prognosis of the arthroscopic lateral retinacular release through the standard anterolateral portal; the results of condylar chondropathies and débridement and drilling applied to the chondropathies were also evaluated. Mediopatellar plica was seen to play a mechanical role in the development of medial femoral chondropathy, which confirms that excision of plica is a prophylactic procedure. A further successful method is lateral retinacular release applied through the standard anterolateral portal with conventional methods without using a third portal at the cases with patellar lateral compression syndrome, patellar lateralization, and patellar lateral subluxation. Classical débridement and drilling methods are cheap and easy for the treatment of chondropathy. We consider these methods still to be useful methods of treatment.

Patellar metastasis from a lung epidermoid carcinoma.

Patellar metastases are very rare. There have been approximately 20 cases reported in the literature. We have also noted two other reports of patellar metastasis from lung carcinoma as the first manifestation of lung cancer in our literature review. We present a case of patellar metastasis as the first manifestation of lung epidermoid carcinoma in a patient who was a smoker for 33 years.