Intra-articular bupivacaine as treatment for postoperative pain after arthroscopy of the wrist

Intra-articular injection of local anaesthetic is a confirmed method of treatment of postoperative pain, particularly after arthroscopy of the knee. The wrist however, has a limited capacity for intra-articular instillation of local anaesthetic, and the aim of this study was to investigate the effect of intra-articular bupivacaine on postoperative pain after arthroscopy of the wrist. We did a prospective, non-randomised study with two comparable, consecutive series of patients undergoing diagnostic/therapeutic wrist joint arthroscopy 20 of whom were given intra-articular 0.5% bupivacaine 5 ml at the end of the arthroscopic procedure and 20 of whom were not. Postoperative pain and use of analgesics (morphine, non-steroidal anti-inflammatory drugs (NSAID) and paracetamol) were recorded in all patients during the following five postoperative days using a visual analogue scale (VAS) and a pain diary. The bupivacaine group reported less pain and less use of analgesics in the first postoperative hours, but for the remaining five postoperative day's pain and the use of analgesics were similar in the two groups. We conclude that intra-articular injection of 0.5% bupivacaine 5 ml after wrist joint arthroscopy reduces pain and use of analgesics during the first postoperative hours, but has no effect during the following five days.