The Effects of Preoperative Inflammation on the Analgesic Efficacy of Intraarticular Piroxicam for Outpatient Knee Arthroscopy Seval Izdes, MD*, Sibel Orhun, MD†, Sacit Turanli, MD‡ Ezgi Erkilic, MD*, and Orhan Kanbak, MD* From the Departments of *Anesthesia, †Pathology, and ‡Orthopaedic Surgery, Emergency And Traumatology Hospital, Ankara, Turkey We conducted a double-blinded study in 90 patients undergoing elective arthroscopic knee surgery to deter- mine whether there is a role of inflammation in the an- algesic efficacy of intraarticular piroxicam. Standard- ized general anesthetic techniques were used for all patients. At the end of the operation, after harvesting synovial biopsies, patients were randomized into three intraarticular groups equally. Group 1 received 25 mL saline, Group 2 received 25 mL 0.25% bupivacaine, and Group 3 received 25 mL 0.25% bupivacaine and piroxi- cam 20 mg. After microscopic examination of the syno- vial materials, the patients were divided into two sub- groups, inflammation positive (I+) and inflammation negative (I-). Preoperatively and postoperatively at 1, 2, 4, and 6 h, pain levels, analgesic duration, and post- operative analgesic consumption were recorded. Anal- gesic duration was significantly longer in the I+ sub- group than the I- subgroup of Group 3 (P  0.05). Pain scores at 1, 2, and 4 h postoperatively were significantly lower in the I+ subgroup than the I- subgroup of Group 3 (P  0.05), whereas there were no significant differences among the subgroups of Group 1 and 2. We concluded that preoperative inflammation is one of the most important determinants of analgesic efficacy of in- traarticular piroxicam. (Anesth Analg 2003;97:1016 –9) A rthroscopy of the knee joint is one of the most common operations performed on an ambula- tory basis. The success of ambulatory surgery depends to some extent on effective control of post- operative pain. A variety of analgesic techniques have been used to manage postoperative pain after arthro- scopic knee surgery. The ideal would be to provide adequate local analgesia of long duration without any side effects (1,2). Intraarticular drug use has become widespread, and thus local anesthetics, opioids, and nonsteroidal antiinflammatory drugs (NSAIDs) alone or in combined forms are used to enhance their effec- tiveness (2– 4) in providing satisfactory analgesia after day-case knee arthroscopies. However, NSAIDs ad- ministered intraarticularly produce conflicting data with respect to their analgesic efficacy (3,5). These controversial results may be related to the presence of inflammation in the joint space structures before the operation. This clinical trial was therefore designed to determine whether preoperative inflammation has a role in analgesic efficacy of intraarticular piroxicam after arthroscopic knee surgery. Methods After obtaining local ethics committee approval and written informed consent, 90 unpremedicated ASA physical status I and II patients scheduled for outpa- tient arthroscopic knee surgery were enrolled in the study. Patients receiving analgesics preoperatively, having a contraindication to receive NSAIDs, or re- quiring knee drainage were excluded from the study. Before the operation all patients received instructions for using a 10-cm visual analog scale (VAS), with 0 = no pain to 10 = the worst imaginable pain, and base- line pain scores at rest were recorded. In all patients, anesthesia was induced with propofol 2.5 mg/kg IV and alfentanil 10 g/kg IV and laryngeal masks (no: 3/4) were placed. Anesthesia was maintained with 1.5%–2% sevoflurane and 65% nitrous oxide in oxy- gen. No other supplementary analgesic medication was given during the operation after the first dose of Accepted for publication May 23, 2003. Presented in part at the 10th ESA Anniversary Meeting and 24th EAA Annual Meeting Euroanaesthesia 2002, Nice, France, 6 –9 April 2002. Address correspondence and reprint requests to Seval Izdes, MD, 39 Sokak No:11/3 06500, Bahcelievler Ankara, Turkey. Address email to sevalizdes@yahoo.com. DOI: 10.1213/01.ANE.0000081725.81280.17 ©2003 by the International Anesthesia Research Society 1016 Anesth Analg 2003;97:1016–9 0003-2999/03