Assessment of Intraoperative Intra-articular Morphine and Clonidine Injection in the Acute Postoperative Period After Hip Arthroscopy

Abstract

Background:Previous authors have suggested that intra-articular morphine and clonidine injections after knee arthroscopy have demonstrated equivocal analgesic effect in comparison with bupivacaine while circumventing the issue of chondrotoxicity. There have been no studies evaluating the effect of intra-articular morphine after hip arthroscopy.Purpose:To evaluate the efficacy of intra-articular morphine in combination with clonidine on postoperative pain and narcotic consumption after hip arthroscopy surgery for femoroacetabular impingement.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective chart review was performed on 43 patients that underwent hip arthroscopy for femoroacetabular impingement at a single institution between September 2014 and May 2015. All patients received preoperative celecoxib and acetaminophen, and 22 patients received an additional intra-articular injection of 10 mg morphine and 100 μg of clonidine at the conclusion of the procedure. Narcotic consumption, duration of anesthesia recovery, and perioperative pain scores were compared between the 2 groups.Results:Patients who received intra-articular morphine and clonidine used significantly less opioid analgesic (mEq) in the postanesthesia recovery (median difference, 17 mEq [95% CI, –32 to –2 mEq]; P = .02) compared with the control group. There were no differences in time spent in recovery before hospital discharge or in visual analog pain scores recorded immediately postoperatively and at 1 hour after surgery.Conclusion:Intraoperative intra-articular injection of morphine and clonidine significantly reduced the narcotic requirement during the postsurgical recovery period after hip arthroscopy. The reduction in postsurgical opioids may decrease adverse effects, improve overall pain management, and lead to better quality of recovery and improved patient satisfaction.

Synovial membrane receptors as therapeutic targets: A review of receptor localization, structure, and function

“…Drugs such as local anesthetics are classically known for their chondrotoxic effects while morphine may provide a less chondrotoxic option for intra‐articular analgesia …”

Editorial Commentary: Emergency Department Evaluation After Hip Arthroscopy Occurs More than Expected: Here’s Where Patient Education and a Multimodal Approach to Pain Management Can Be Helpful

“…[8][9][10][11] Supplemental forms of anesthesia before, during, and after certain arthroscopic procedures have also been shown to significantly reduce opioid consumption. 12,13 Given that only 4% of patients in the study required an inpatient admission, many of these ED visits may have been preventable. By enforcing a multimodal approach to pain management and perioperative patient education surrounding narcotic use, the burden on the health care system following hip arthroscopy may be reduced further still.…”

Implementing enhanced recovery pathways to improve surgical outcomes

“…[ 7 8 ] In a study by Cogan et al ., the authors reported a significant decrease in the need for opioids after surgery when an intraoperative intra-articular injection of morphine and clonidine was used. [ 9 ] In another study conducted in renal transplant patients, patient-controlled analgesia morphine requirements were significantly reduced after surgery in the ERAS group versus the non-ERAS group. [ 10 ] Despite limiting opioid usage preoperatively and decreased pain scores and the need for opioids after surgery, the culture of prescribing pain medications postoperatively after discharge has remained unchanged.…”