Patients and method:

164 patients undergoing total knee arthroplasty were randomly divided into 8 groups. The study groups are, group 1 (preB), preincisional bupivacaine, postincisional saline; group 2 (postB), preincisional saline, postincisional bupivacaine; group 3 (preBK), preincisional bu-pivacaine+ ketamine, postincisional saline; group 4 (postBK), preincisional saline, postincisional bu-pivacaine+ ketamine; group 5 (preBKV), preincisional bupivacaine+ ketamine+ verapamil, postin-cisional saline; group 6 (postBKV), preincisional saline, postincisional bupivacaine+ ketamine+ verapamil; group 7 (preBV), preincisional bupivacaine+ verapamil, postincisional saline; group 8 (postBV), preincisional saline, postincisional bupivacaine+ verapamil. Doses of epidural adminis-tered drugs are: 50 mg 0.5% bupivacaine solution, 60 mg ketamine, 5 mg verapamil, 10 mL saline. After placing epidural catheter, general anesthesia was administered with standart monitorisation. Epidural drugs were administered, 15 minutes before surgical incision for preincisional application and 30 minutes after surgical incision for postincisional application. Emergence, pain score and an-algesic requirement, side effects, patient and practitioner satisfaction were recorded.

Findings:

Ketamine and/or verapamil combinations’ analgesic effects are better than bupivacaine administered alone. Analgesic consumptions of combination groups are similar in the first 24 hour period but in the second 24 hour period combinations of verapamil have lesser consumption. An-algesic consumptions of all preemptive groups are lesser than postincisional groups, in the global evaluation, group preBKV is the best group in patient and practitioner satisfaction.

Result:

Adding ketamine and verapamil to epidural bupivacaine enhances effectiveness and dura-tion of analgesia, preemptive administration is more effective than the postincisional administra-tion on postoperative analgesic requirements.

Keywords: Postoperative pain, knee replacement surgery, analgesic consumption, bupivacaine, ketamin, verapamil, epidural