Addition of morphine to intra-articular bupivacaine does not improve analgesia after day-case arthroscopy

Abstract

We conducted a randomized, double-blind, controlled study in patients undergoing day-case knee arthroscopy to evaluate the analgesic effect, for 36 h after operation, of the addition of either 2 mg or 5 mg of morphine to intra-articular bupivacaine. Patients in group BM5 (n = 20) received 0.25% bupivacaine 40 ml with morphine 5 mg; patients in group BM2 (n = 20) received 0.25% bupivacaine 40 ml with morphine 2 mg and patients in group B0 (n = 18) received 0.25% bupivacaine 40 ml only. The drugs were given by intra-articular injection by the surgeon at the end of the operation and the tourniquet released 10 min later. Preoperative and postoperative pain was assessed over the ensuing 36 h, at rest and with movement, using a 100-mm visual analogue scale. There were no significant differences in pain scores, consumption of additional analgesia, or time to first request for analgesia between any of the groups. We conclude that, after day-case knee arthroscopy, no additional analgesic effect was afforded by the addition of morphine to intra-articular bupivacaine.

Analgesia intra-articular com morfina, bupivacaína ou fentanil após operação de joelho por videoartroscopia

“…Other factors in the literature that could interfere with results would be intra-articular injection volume and tourniquet maintenance time after drug injection. Several studies used large analgesic volumes 14,24,26,29 ; however, there is no consensus on the ideal intra-articular injection volume. Our study used 10 ml because, according to some authors 15 , a higher volume could result in leakage of part of the injected content.…”

“…Talvez, se estes medicamentos fossem avaliados em outros procedimentos, os resultados teriam sido diferentes. Outros fatores descritos na literatura que poderiam interferir nos resultados seriam o volume de injeção intra-articular e o tempo da permanência do garrote após a injeção dos fárma-cos. Em muitos estudos foram utilizados grandes volumes de solução analgésica 14,24,26,29 ; entretanto, não existe consenso sobre o volume ideal para a injeção intra-articular. No presente estudo optou-se pelo volume de 10 ml, pois, de acordo com outros autores 15 , um volume maior poderia resultar no extravasamento de parte do conteúdo injetado.…”

“…As doses dos fármacos deste estudo corresponderam às utilizadas na literatura. Amaior parte dos trabalhos não apresentou diferença significativa nos resultados obtidos 5,8,[12][13][14]20,29,31,37,38 . Entretanto, alguns trabalhos obtiveram melhor efeito analgésico com a morfina [24][25][26] e outros com a bupivacaína 4,9,10, 16,17 .…”

Postoperative Effectiveness of Three Routes of Morphine in Arthroscopic Knee Surgery

“…(1,6,(15)(16)(17) Intraarticular use of morhine is contraversial with some positive (1,(16)(17)(18) and some negative results. (19)(20)(21) Thus the authors recommended further randomized controlled trials to clarify the contradictory results published in the literature. (15) The effect of intraarticular morphine has been attributed to the presence of peripheral opioid receptors, because the analgesic effect could be reversed by the injection of intraarticular naloxone.…”

Comparison of Analgesic Effect of Intra-Articular Buprenorphine and Morphine Following Arthroscopic Surgery of Knee

“…[1][2][3][4][5][6][7][8] In contrast, other investigators have failed to demonstrate an analgesic effect of IA morphine. [9][10][11][12][13][14][15] Morphine is the most frequently used opioid analgesic. Buprenorphine is a partial agonist with a higher receptor affinity than morphine, which accounts for intense and J. Evolution Med.…”