Purpose: The aim was to determine whether intra-articular bupivacaine provides effective analgesia following ankle arthroscopy and whether it reduces the need for supplemental analgesia.

Methods: A power calculation revealed that 40 patients were required to provide a 5% significant level using a visual analogue scale. 40 patients were therefore randomised to receiving 20 mls of either bupivacaine or saline (control) after routine anterior ankle arthroscopic surgery. The tourniquet was released 10 minutes later. In recovery, supplementary analgesia of 2 tablets of co-codomol 30/500 orally or 50–100mg tramadol IV was available on request. A 10 day supply of 50mg diclofenac (8 hourly) and co-codomol 30/500 2 tablets (6 hourly) was provided.

A visual analogue scale (VAS) was employed as a direct indicator of pain and indirectly, supplemental analgesic requirement. Measurements were made pre-operatively and postoperatively.

Age, weight and tourniquet times were compared with Mann Whitney U test and Chi-square. Pain scores and analgesic requirements were compared using ANOVA at a 5% significance level.

Results: Pain scores were lower in the bupivacaine group compared to the control as was the need for supplemental analgesia.

Significance: We conclude that postoperative intraarticular bupivacaine provides effective analgesia following ankle arthroscopy.

The intra-articular injection of local anaesthetic is frequently used for pain relief after arthroscopy. There is, however, no published evidence of the analgesic effect of bupivacaine in the ankle. In a randomised, double-blind study, 35 patients undergoing arthroscopy of the ankle were allocated to receive intra-articular saline or bupivacaine. Pain was assessed using pain scores and additional analgesic requirements. Intra-articular bupivacaine had a significant analgesic effect in the immediate post-operative period, reducing pain scores and the need for additional analgesics.

We recommend the use of intra-articular bupivacaine for post-operative analgesia in ankle surgery.