The Effect Of Ketorolac Injection Into The Articular Cavity On Pain Control After Knee Arthroscopy:A Meta-analysis Of Randomized Controlled Trials

Introduction: Enhanced recovery after surgery(ERAS)is one of the main development directions of orthopedics.ERAS can obviously promote functional recovery and improve the surgical effect of patients.The core of ERAS is to alleviate the stress response of the body to the surgical trauma through a series of optimal measures for perioperative management,so as to achieve a rapid recovery of patients.It not only requires minimally invasive surgery,but also requires the implementation of perioperative rehabilitation management.The obvious pain seriously hinders the early recovery of these patients,so good postoperative analgesia is critical.The efficacy of ketorolac injection into the articular cavity on pain control after knee arthroscopy remains controversial.We conduct a systematic review and meta-analysis to explore the impact of ketorolac supplementation on pain intensity after knee arthroscopy.Materials and Methods: We search PubMed,EMbase,Web of science,EBSCO,and Cochrane library databases through September 2018 for randomized controlled trials(RCTs)assessing the effect of ketorolac injection into the articular cavity versus placebo on pain management after knee arthroscopy.This meta-analysis is performed using the random-effect model.Results: Ten RCTs involving 402 patients are included in the meta-analysis.Overall,compared with control group for knee arthroscopy,ketorolac injection into articular injection is associated with notably reduced pain scores at 1 h(Std.MD=-0.66;95% CI=-1.12 to-0.21;P=0.004)and 2 h(Std.MD=-0.90;95% CI=-1.74 to-0.07;P=0.03),prolonged time for first analgesic requirement(Std.MD=1.94;95%CI=0.33 to 3.55;P=0.02)and decreased number of analgesic requirement(RR=0.41;95% CI=0.23 to 0.75;P=0.003),but has no obvious impact on analgesic consumption(Std.MD=-0.56;95% CI=-1.14 to 0.02;P=0.06),as well as nausea and vomiting(RR=0.44;95% CI=0.12 to 0.21;P=0.21).Conclusions:(1)Aceelerated rehabilitation surgery(ERAS)is one of the major surgical development directions,it can obviously promote the functional recovery and improve the surgical effect.Early functional exercise is needed after knee arthroscopy,and good postoperative analgesia is very important.(2)Intra-articular injection of drugs is the most commoly used method for postoperative analgesia,which takes effect quickly,the drugutilization rte is high,the systemic adverse reaction is few,and is simple to operate and has low technical requirements.(3)NSAIDs drug ketorolac,as a non selective COX inhibitor,can enhance the analgesic effect and prolong the time of analgesia through intra-articular injection in cooperation with local anesthetics.It has good analgesic effect and less adverse reactions after intra-articular injection,which has a good effect on pain control after knee arthroscopy.