A Systematic Review of the Peripheral Analgesic Effects of Intraarticular Morphine

Abstract

The analgesic effects of intraarticular morphine are controversial. To systematically evaluate the effects, we performed a review of the literature and a metaanalysis of the peripheral effects of morphine injected intraarticularly. Research databases were searched to identify articles in which peripheral analgesic effects of morphine were studied in patients undergoing arthroscopic knee procedures under local, regional, or general anesthesia. The review was performed on three issues: does morphine injected intraarticularly produce analgesia, is it a dose-dependent effect, and, if so, is the effect systemic or mediated via peripheral opioid receptors? Visual analog score (VAS) and analgesic consumption were studied during the early phase (0-2 h), intermediate phase (2-6 h), and late phase (6-24 h) postoperatively after injection of morphine intraarticularly. Metaanalysis of these effect variables was performed by the weighted-analysis technique, and the essential homogeneity assumption was tested by the chi(2) test. Forty-five articles could be identified in which the effects of morphine were studied in a prospective, randomized manner, and 32 of these studies included a placebo control. Pooled analyses of data from 19 studies suitable for metaanalysis showed an improvement in analgesia after morphine compared with placebo in the order of 12-17 mm on the VAS during all three phases of treatment. Studies with high quality scores showed somewhat smaller improvements. Total analgesic consumption could not be analyzed statistically, but the number of studies showing decreased analgesic consumption or no differences between groups was identical (six and six). No clear dose-response effect was seen when VAS was used as a measure of pain, but it was seen when area under the curve was used as a measure of pain. A systemic effect of peripherally-injected morphine was not possible to exclude because of the very limited data available. We conclude from this metaanalysis that intraarticularly administered morphine has a definite but mild analgesic effect. It may be dose dependent, and a systemic effect cannot be completely excluded.

Addition of fentanyl to the ultrasound-guided transversus abdominis plane block does not improve analgesia following cesarean delivery

“…Murphy et al (24) reported that opioids had limited benefits as analgesic adjuncts to the brachial plexus block, whereas they were shown to exert a definite but mild analgesia following intraarticular injection in another study (25). Fentanyl is an opioid that has been widely used as an analgesic adjunct to LAs in clinical practice.…”

Modulation of Peripheral Sensory Neurons by the Immune System: Implications for Pain Therapy

“…Several reviews have extensively analyzed the literature on intra-articular opioids. Although the majority agree on the analgesic efficacy of intra-articular morphine (Gupta et al, 2001;Kalso et al, 2002;Sawynok, 2003), some do not (Rosseland, 2005). Most commonly, negative results have been attributed to lack of study sensitivity (i.e., patients did not have sufficiently high baseline pain scores to detect a significant reduction), lack of tissue inflammation, or the superimposition of general or local anesthetic effects (Kalso et al, 2002;Rosseland, 2005;Stein, 2006).…”

Postoperative Effectiveness of Three Routes of Morphine in Arthroscopic Knee Surgery

“…(1)(2)(3)(4)(5)(6)(7) Intrathecal (IT) or intraarticular (IA) injection of opioids has been reported to provide adequate pain control after arthroscopic knee applications. (1)(2) The peripheral analgesic effect of morphine has been widely studied and compared with other analgesics, local anesthetics and placebo for about 20 years. (2) IA injection of morphine with a range of 1 mg to 10 mg has been reported to achieve sufficient analgesia in many studies.…”

“…(1)(2) The peripheral analgesic effect of morphine has been widely studied and compared with other analgesics, local anesthetics and placebo for about 20 years. (2) IA injection of morphine with a range of 1 mg to 10 mg has been reported to achieve sufficient analgesia in many studies. (2,3) Overall evaluation of the literature in systematic reviews suggested a beneficial analgesic effect of morphine compared to placebo.…”

“…(2) IA injection of morphine with a range of 1 mg to 10 mg has been reported to achieve sufficient analgesia in many studies. (2,3) Overall evaluation of the literature in systematic reviews suggested a beneficial analgesic effect of morphine compared to placebo. (2,3) Mechanism of peripheral analgesia provided by local injection of morphine has been related with activation of peripheral opioid receptors.…”