Synovial fluid replacement reduces postoperative pain after elbow arthroscopic surgery compared with local anaesthetic 

R Davies, R Carter, N Phillips, C Peach


Background:

Post-operative pain is common after elbow arthroscopic surgery. Previous studies in the knee and shoulder have examined the use of synovial fluid replacement with hyaluronan after arthroscopy to assist in the management of post-operative pain due to its positive effects on reducing joint pain and swelling as well as increasing mobility.

Aim:

The aim of this study was to examine the effect of the addition of a synovial fluid replacement on early post-operative pain and function in the first 3 weeks after arthroscopic surgery in the elbow compared with local anaesthetic.

Methods:

20 patients undergoing elbow arthroscopy for osteocapsular arthroplasty or capsular release for post-traumatic stiffness were included. Patients received either 10ml 0.75% Ropivacaine (AstraZeneca, UK) or 10ml Viscoseal (TRB Chemedica, UK) intra-articularly at the end of the procedure. Visual analogue scores (VAS) in hospital, after discharge recorded with a pain diary and at 3 week follow up, were analysed. Patients were blinded to treatment arms.

Results:

Pain scores pre-operatively and before discharge were similar between the two groups. Pain on the night following surgery was significantly higher in the local anaesthetic group (mean VAS 6.8) than the hyaluronan group (mean VAS 3.6) P=0.0001. At three week follow up, the worst recalled mean VAS in the post operative period was higher in the local anaesthetic group (6.4 vs. 3.2; P=<0.0001). Pain at the time of three week follow up was similar (1.4 vs 1.0; P=0.278).

Conclusion:

Patients receiving synovial fluid replacement after elbow arthroscopy have significantly reduced pain scores in the immediate post operative period. There appears to be a post operative flare of pain in patients having intra-articular local anaesthesia which is not present in the hyaluronan group and may suggest a protective effect. The differences between the two groups were similar at the three week post operative visit. This study demonstrates that Viscoseal is more effective than local anaesthetic in the management of post elbow arthroscopy pain in the three weeks following surgery.

By permission of 
Chris Peach MD FRCS (Tr&Orth)
Consultant Elbow and Shoulder Surgeon
Cheshire Shoulder and Elbow Clinic