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This is with reference to the original article titled “Pain relief following Arthroscopy - a comparative study of Intra-articular Bupivacaine, Morphine & Neostigmine” (MJAFI 2004;60:123-7). Following are offered as comments on the subject:
The author included many variables for assessment of drug efficacy for post arthroscopy pain, i.e. sex, weight, age, volume of injected lignocaine, anaesthetized dermatomes & surgical time. However a very important variable (perhaps, the most important) was not considered which is the nature of arthroscopic surgery performed on the knee. The arthroscopic surgeries of the knee include a wide spectrum of procedures ranging from diagnostic arthroscopy, menisectomy, meniscal repair, retinacular releases, loose body removal, synovectomy, biopsy, fracture fixation to cruciate ligament reconstruction / repair.
The tissues being operated upon range from poorly innervated menisci to extremely sensitive cruciate ligaments . Therefore, the pain following arthroscopy depends a lot upon the tissues operated upon i.e. repaired, reconstructed or excised during the arthroscopic procedure as the tissue may be meniscus, cruciate ligament, synovium, cartilage or bone. All these tissues have different extent of innervation & hence severity of pain is likely to vary and so will be the efficacy of drugs delivered locally. Now, if the author's variables considered in the study are incomplete, i.e. nature of surgery not considered in this study, then the results and conclusion of the study are not likely to be fully valid.
It should now be realized that arthroscopy includes a vast number of therapeutic & diagnostic procedures which has led to recognition of arthroscopy as a highly specialized separate subspecialty of orthopaedics. It is no more a simple diagnostic procedure of 1960 and 70s.