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Online ISSN 1827-1596
Berti M., Albertin A., Casati A., Palmisano S., Municino G. *, da Gama Malcher M. **, De Ponti A. **
From the Università degli Studi - Milano Dipartimento di Anestesia e Rianimazione, IRCCS H. San Raffaele - Milano (Direttore: Prof. G. Torri)
*Seconda Università degli Studi - Napoli
**Università degli Studi - Milano Clinica Ortopedica IRCCS H. San Raffaele, Milano (Direttore: Prof. L. Tessari)
Background. This prospective, randomized study was conducted to evaluate the quality of postoperative pain relief when using dexketoprofen, ketoprofen, or paracetamol after outpatient knee arthroscopy.
Methods. Without premedication, 45 ASA physical status I-II patients undergoing elective outpatient knee arthroscopy with combined sciatic-femoral nerve block, were randomly allocated to receive either 25 mg oral dexketoprofen (n=15), 50 mg oral ketoprofen (n=15), or 500 mg oral paracetamol (n=15) before block placement. After completion of surgery the same pain medication was given according to standard protocols, while 50 mg oral tramadol were allowed as rescue analgesic if required by the patient. After standard discharge criteria had been fulfilled, patients were discharged from the day-surgery unit, while a telephone follow-up was performed the day after surgery using standard questionnaires evaluating the quality of pain relief during the first 24 hours after surgery. Total consumption of rescue tramadol, maximum pain complained of after hospital discharge, as well as the visual analogue scale of pain measured at hospital discharge were assessed by an independent trained observer.
Results. No differences in anthropometric variables, duration of surgical procedure, and fulfilment of discharge criteria were observed between the three groups. The degree of pain measured at rest at hospital discharge was similar in the three groups, while the VAS measured during motion was higher in patients receiving paracetamol (24±2.5 mm) than in those patients treated with dexketoprofen (13±6 mm) or ketoprofen (17±5 mm) (p=0.016). Two patients (one in ketoprofen group and one in paracetamol group) required rescue tramadol after hospital discharge; however, no differences in maximum pain complained of after surgery or patient acceptance were observed between groups.
Conclusions. This prospective, randomized study demonstrated that in outpatients receiving arthroscopic knee surgery, the use of 75 mg/day dexketoprofen was as effective and safe as 150 mg/day racemate ketoprofen, with a better pain relief during motion compared to 2 g/day paracetamol when patients were discharged from the day-surgery unit.