Bupivacaina ou bupivacaina e morfina intra-articular pós reconstrução do LCA

Abstract

ObjectiveReconstructive surgery of the ACL is one of the most commonly performed surgeries today and the control of postoperative pain is part of the priorities of the surgeon. Within the arsenal of analgesia we have the intra-articular application of drugs, and the most studied one is bupivacaine with or without morphine. This study compared the application of bupivacaine with or without morphine with a control group after ACL reconstruction with flexor tendon graft.MethodsForty-five patients were randomized into three groups: in group I, 20 ml of saline were applied intra-articularly at the end of the surgery; in group II, 20 ml of bupivacaine 0.25%; and in group III, bupivacaine 0.25% associated with 1 mg of morphine. The groups were assessed for degree of pain by the Visual Analog Scale at 6, 24 and 48 hours postoperatively.ResultsGroup III had less pain at all times, but the pain was not as intense in all groups to the point of needing extra medications beyond the established protocol.ConclusionThe intra-articular application of these medications after ACL reconstruction with flexor tendon graft when performed under spinal anesthesia is not useful enough to use regularly. Level of Evidence II, Lesser quality RCT

Single-dose intra-articular bupivacaine plus morphine after knee arthroscopic surgery: a meta-analysis of randomised placebo-controlled studies

“…The results described above are supported by some studies [11][12][13][14][15][16][17][18][19] but not by others. [20][21][22] The conflicting findings may be due to various factors.…”

“…This quantitative meta-analysis involving 12 RCTs [11][12][13][14][15][16][17][18][19][20][21][22] showed that the combination therapy of single-dose IA bupivacaine and morphine is effective for pain relief after knee arthroscopic surgery. There was no significant difference between the two groups in terms of side effects.…”

“…All 12 included articles [11][12][13][14][15][16][17][18][19][20][21][22] reported pain intensity using VAS scores, but one 21 figure 2A, B. Sensitivity analysis explored the potential sources of heterogeneity between the bupivacaine plus morphine group and the placebo group and investigated the influence of various exclusion criteria on the overall risk estimate.…”

“…[4][5][6][7][8][9][10] However, the efficacy and safety of this combination for patients undergoing knee arthroscopic surgery remains controversial. Some studies found that IA bupivacaine plus morphine provided effective pain relief for patients, [11][12][13][14][15][16][17][18][19] while others did not. [20][21][22] Consequently, this quantitative meta-analysis involving 12 randomised placebo-controlled trials (RCTs) was designed to examine the efficacy and safety of IA bupivacaine in combination with morphine for patients undergoing knee arthroscopic surgery.…”

Comparison of intra-articular analgesics in arthroscopic anterior cruciate ligament reconstruction surgeries: A randomized controlled trial

“…Various studies have been done previously to study analgesic efficacy of intra-articular local anesthetics,[ 3 ] morphine,[ 4 5 ] clonidine,[ 6 7 ] dexmedetomidine,[ 8 9 ] etc., with varying results.…”