Optimizing Post-operative Pain Management in Knee Arthroscopy: A Double-Blinded Randomized Controlled Trial of Regional Anesthesia with and without Local Infiltration

Introduction: Internal derangement of the knee (IDK) is among the most common musculoskeletal conditions managed in orthopedic practice, with knee arthroscopy serving as the gold standard for its surgical treatment. Despite the minimally invasive nature of the procedure, post-operative pain remains a significant barrier to early rehabilitation and functional recovery. This study evaluated whether intraoperative infiltration of a local anesthetic cocktail at the hamstring donor site and intra-articullarly offers superior immediate post-operative pain control compared to regional spinal anesthesia alone. Materials and Methods: This prospective, double-blinded, and randomized controlled study was conducted at the Department of Orthopaedics, Yashoda Hospital, Secunderabad, over 1 year. Sixty patients with IDK undergoing arthroscopic surgery were randomly allocated into two groups of 30 each. Group-A received intraoperative infiltration of 0.2% ropivacaine (25 mL) with 0.2% clonidine at the donor hamstring site and intra-articullarly in addition to regional spinal anesthesia, while Group-B received regional spinal anesthesia alone. Post-operative pain was assessed using the Visual Analogue Scale (VAS) in the immediate post-operative period. Statistical analysis was performed using Statistical Package for the Social Sciences version 20, with P < 0.05 considered significant. Results: Both groups were comparable in terms of age (mean 31.3 ± 8.54 vs. 32.73 ± 7.65 years; P = 0.5) and sex distribution (P = 0.75). Road traffic accidents constituted the most frequent mechanism of injury in both groups. Immediate post-operative VAS scores were significantly lower in Group-A compared to Group-B (mean 0.53 ± 1.04 vs. 4.67 ± 1.84; P < 0.001), with 76.67% of Group-A patients reporting a complete absence of pain. Conclusion: Intraoperative infiltration of ropivacaine and clonidine at the hamstring donor site and intra-articullarly provides significantly superior immediate post-operative pain relief compared to spinal anesthesia alone, facilitating early mobilization and improved orthopedic recovery following knee arthroscopy.