Intra-articular infiltration of bupivacaine in arthroscopic knee surgery: Dexamethasone versus magnesium sulfate as adjuncts

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Published Aug 1, 2025
https://doi.org/10.62438/tunismed.v103i8.5649
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Vol. 103 No. 8 (2025): Tunis Med Aug 2025

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Hajer Arfaoui
Department of anesthesia and intensive care, Mongi Slim Hospital,La Marsa, Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Faten Haddad
Department of anesthesia and intensive care, Mongi Slim Hospital,La Marsa, Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Maha Mensi
Department of anesthesia and intensive care, Mongi Slim Hospital,La Marsa, Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Amani Bel Haj Youssef
Department of anesthesia and intensive care, Mongi Slim Hospital,La Marsa, Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Emna Kammoun
Service d'anesthésie et de soins intensifs, Hôpital Mongi Slim, La Marsa, Faculté de médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie.
Mhamed Sami Mebazaa
Department of anesthesia and intensive care, Mongi Slim Hospital,La Marsa, Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.

Abstract

Introduction: Knee arthroscopy is a common procedure in orthopedics due to its minimally invasive nature. However, it often leads to moderate to severe postoperative pain, especially within the first 24 hours. Several studies demonstrated the efficiency of intra-articular infiltration of analgesics but the optimal infiltration mixture remains a topic of debate.


Aim: The aim of our study was to assess the analgesic role of Dexamethasone or Magnesium Sulfate as adjuncts to intra-articular Bupivacaine after knee arthroscopic surgery.


Methods: It was a prospective randomized double-blinded study including 75 adult patients classified according to the American Society of Anesthesiology (ASA) I-II and undergoing arthroscopic knee surgery under spinal analgesia. They were divided into three groups of 25 each. All patients received intra articular infiltration at the end of surgery: group B received 10 ml of saline solution with 10 ml of bupivacaine 0.5%, group D received 4 mg of dexamethasone in combination with bupivacaine and group Mg received 1.5 g of magnesium sulfate in combination with bupivacaine. Postoperative rescue analgesia was insured by a patient-controlled analgesia (PCA) morphine. The primary outcome was morphine consumption during the first 24 hours after surgery.


Results: The cumulative morphine dose was higher in group B compared to group D and Mg (p=0.001 and p<0.001, respectively). Group D and group Mg showed comparable cumulative morphine doses (p=0.52). At 24 hours postoperatively, static visual analog scale (VAS) scores were higher in the control group compared to group Mg and group D ....( abstract truncated at 250 words).

Keywords:

Analgesia, Knee joint, Arthroscopy, Intra-articular injection, Dexamethasone, Magnesium sulfate, Bupivacaine

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