الفهرس 
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Abstract
The effective relief of pain is a paramount importance for patients undergoing surgery. This should be achieved for humanitarian reasons, but there is now evidence that pain relief has significant physiological effects. Not only does effective pain relief means a smoother postoperative course with earlier discharge from hospital, but it may also reduce the onset of chronic pain syndromes.
Opioids analgesics continue to play an important role in the acute treatment of moderate-to-severe pain in the early postoperative period. However, non-opioid analgesics are increasingly being used as adjuvant before, during, and after surgery to facilitate the recovery process after ambulatory surgery because of their ability to reduce postoperative pain (with movement) and absence of opioid-related side effects thereby shortening the duration of the hospital stay and the convalescence period.
The administration of intra-articular ketamine for the same purpose recently received renewed attention as an analgesic intervention.
The aim of study was to evaluate the analgesic efficacy of intra-articular ketamine in patients undergoing knee arthroscopy.The present study was carried out in El-Hadara University Hospital on 50 adult patients of sex, ASA physical status I or II, and scheduled for elective knee meniscectomy under general anaesthesia.Patients in the study were classified in a randomized, double- blind trial study into two equal groups by the closed envelope method. Group I: Intra-articular injection of ketamine 0.5 mg /kg body weight in10mlnormal saline.Group II Intra-articular injection of 10 ml normal saline as placebo.All Patients were monitored using standard monitoring (pulse oximetry, electrocardiogram, noninvasive arterial blood pressure monitoring). A balanced anaesthetic technique using general anaesthesia with fentanyl (1 mcg/kg) and propofol (2.0 mg/kg) and oro-tracheal intubation was facilitated by rocuronium bromide (0.5-0.6 mg/kg) then patients were mechanically ventilated. Anaesthesia was maintained with isoflurane (1.2−1.5%) using 100% oxygen, incremental doses of rocuronium and controlled ventilation all over the time of surgery. At the end of surgery, a combination of atropine (0.01 mg/kg) and neostigmine (0.04mg/kg) were administered to reverse the residual neuromuscular blockade and extubation after full recovery then patients transferred to PACU. At the end of operation the study drugs will be injected in the operated knee under complete aseptic technique by the surgeon as mentioned.The following parameters were measured in the 1st 24 hours of postoperative period:
• Pain assessment using Visual analogue scale (VAS) at 4, 8, 12, 16, 20, 24 hours postoperatively.• Time elapsed till 1st rescue analgesic dose needed by patient.
• Total dose of analgesic requirements.
The following results were obtained:
• At different intervals there is significant increase in VAS in placebo group at 4, 8, 12, 16, 20 and 24 hours postoperatively more than ketamine group in both rest and movement where P values was<0.001* at all intervals.
• It also revealed that time elapsed till first analgesic dose showed significant increase in ketamine group (P <0.001*).
• Total meperidine analgesic dose required was significantly higher in placebo group (P <0.001*) and total paracetamol analgesic dose required was significantly higher also in placebo group (P <0.001*).