Dear Thierry

I am using a combination of medications according the pathology.

1. Simple arthroscopy with or without meniscectomy.

    Lignocaine 1% and Buvocaine 2.5%  10ml in the joint. 

2. Arthroscopic debridement, micro-fractures etc 

     Lignocaine 1% and Buvocaine 2.5% 15ml in the joint.

3. Arthroscopy in presence of OA.

     Buvocaine 2.5% 15ml in the joint.

I do not use steroids after an operation due to fear of infection. 

All patients are given Paracetamol to take home.

A small mistake in number 2

2. Arthroscopic debridement, micro-fractures etc 

     Lignocaine 2% and Buvocaine 2.5% 15ml in the joint

Sorry

I usually prefer IV analgesia. It has been reported that employment of intraarticular anaesthetic such as lidocaine or  bupivacaine may cause chondrocyte death. However, after arthroscopic debridement for knee arthrosis or meniscal damage, the intraarticular employment of hyaluronic acid or platelet rich plasma may help to obtain better results to alleviate pain and improve function.

Dear George and Ruben,

Thank you for these answers. Till now I haven't seen any chondrocytes troubles with these... The problem with PRP and Hyaluronic acid remains the price and our social system doesn't pay for them in these conditions. What do you think about Morphin?

I think it is fine. Also, magnesium sulfate has been usted after knee arthroscopy.

As patients in NHS are operated mainly as day cases morphine is not administered in any form. In the case of inpatient admission and for different procedures this could be one of analgesics which can be given.

10 ml of Bupivacaine 0.5%

i do not give any injection after knee scopies.

10 ml ropivacaïne 7.5mg/ml 

epinephrine 1mg if  ACL or lateral meniscus

I don't give any injection after simple arthroskopy. After reconstructio ACL I used drenage and it is better and chipper solution.

I used 20cc of Marcaine after both procedures and never saw evidence of chondrolysis in 1000's of knee arthroscopies and ACL reconstructions over 25 years. While I have read numerous publications of this condition over the years, it appears to be more consistently associate with the use of pain pumps that deliver an anesthetic solution into the joint over a prolonged period of time. 

chondrolysis after marcaïne seems to exist only in shoulder arthroscopy

Thank you all for your answers. I do agree with most of them and I haven't seen any chondrolysis with Marcaine. Wondering what you all think about Morphine that is supposed to lock the synapses and so prevent any pain feeling...

We are not using any injections in our ACLR, without any noticeable problems. Inj of PRP may seem attractive for graft healing.