Intra-articular remifentanil on postoperative pain in knee arthroscopic surgery; a double blind randomized clinical trial

BACKGROUND

We aimed to assess the efficacy of intra-articular remifentanil in relieving postoperative pain after knee arthroscopy.

METHODS

We conducted a double-blind randomized clinical trial study on 60 patients. Patients were divided into two equal groups. The control group received 25 ml of intra-articular normal saline, and the intervention group received 200 μg of remifentanil dissolved in 25 ml of saline. We evaluated at rest postoperative pain at 1, 3, 6, 12, 18, and 24 h after the surgery using the Visual Analog Scale (VAS). Patients with VAS scores of 4 or more received meperidine (pethidine). The first time meperidine was requested and the total amount of meperidine consumed was recorded.

RESULTS

Out of 60 patients, 49 were male (81.6%), and the mean age of participants was 32.71 (7.02) years. An hour after the surgery, the control group showed a mean VAS score of 8.66 (1.26), and decreased to 2.53 (1.67) at the end of 24 h. The intervention group started with a mean VAS score of 2.23 (1.81) and ended at 0.10 (0.305). All patients in the control group and 11 (36.7%) patients in the intervention group asked for analgesics during follow-up. The mean total meperidine dose in the control and intervention groups was 108.33 (23.97) mg and 13.33 (19.40) mg, respectively (P < 0.001; 95% confidence interval of the difference 83.72 to 106.27).

CONCLUSIONS

Intra-articular remifentanil may decrease postoperative pain and analgesic requirements in patients undergoing knee arthroscopy.

Viability of Equine Chondrocytes After Exposure to Mepivacaine and Ropivacaine In Vitro

Chondrocyte health is altered when exposed to local anesthetics, raising concerns as to the long-term effects of local anesthetics intra-articularly for diagnosis and analgesia. To investigate the drug with the lowest toxic potential, the effect of ropivacaine and mepivacaine on chondrocytes was evaluated. Articular cartilage from normal metacarpophalangeal joints of five equine cadaver specimens was used to establish chondrocyte cultures. Following seven days, chondrocytes were exposed to standard culture medium (DMEM), ropivacaine 7.5 mg/ml (ROP7.5), ropivacaine 10 mg/ml (ROP10), mepivacaine 20 mg/ml (MEP20), mepivacaine 30 mg/ml (MEP 30), and 0.9% saline solution (SAL). Chondrocyte viability was evaluated by trypan blue exclusion, MTT, and flow cytometry via cellular staining with propidium iodide. No differences were observed between treatments following trypan blue exclusion assay. A difference was observed between DMEM and all other treatment groups (P < .0001) with a significant viability drop using the MTT assay. Mepivacaine 20 mg/ml and MEP30 exposure between showed greatest decrease in cellular viability compared to SAL, ROP7.5, and ROP10 (P < .0001). Cellular viability decreased as measured by flow cytometry in all groups compared to DMEM and ROP7.5 (P < .02). Interestingly, the trypan blue, MTT, and flow cytometry assays yielded different results. Although there was no difference using trypan blue, MTT demonstrated that ropivacaine-treated cells had lower viability than DMEM, and cytometry found that ROP7.5 did not differ from DMEM. Results in vitro suggest that short-term exposure to ropivacaine may result in less chondrotoxicity than mepivacaine. In vivo studies are warranted investigating long-term effects of local anesthetics on equine articular cartilage.

Intra articular synovial lipoma of the right tarsometatarsal joint- a rare case report

Intra articular synovial lipomas are very rare and only few cases have been reported till now. We are reporting a rare case of intra articular synovial lipoma of the tarsometatarsal joint in the right foot in a 38-year-old male who presented with dull aching pain in the plantar aspect of the foot while walking. The lesion was resected and subjected to histopathological examination, which showed well defined lobules of mature adipocytes separated by thin fibrous septa and covered by synovial lining. Immunohistochemistry with S100 antigen showed membrane positivity. A diagnosis of intra articular synovial lipoma of the tarsometatarsal joint of the right foot was made. Our English literature search failed to yield any information regarding the occurrence of synovial lipoma in small joints and our case may be the first of its kind.