Comparing the Efficacy of Intra-Articular Application of Morphine and Tramadol on Postoperative Pain After Arthroscopic Knee Surgery

Jazayeri, Seyed Mohammad; Mosaffa, Faramarz; Abbasian, Mohammadreza; Hosseinzadeh, Hamid Reza Seyyed

doi:10.5812/aapm.4815

Cited by 8 publications

(9 citation statements)

References 12 publications

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“…Based on the results of our study, morphine suppository could relief pain after CABG. It seems that morphine can reduce postoperative pain effectively regardless of the route of administration ( 11 ). This study showed that using either of the suppository drugs, morphine sulfate or diclofenac sodium, in post-surgery CABG patients in ICU, can be effective in pain control.…”

Section: Discussionmentioning

confidence: 99%

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Comparing the Effects of Morphine Sulfate and Diclofenac Suppositories on Postoperative Pain in Coronary Artery Bypass Graft Patients

et al. 2014

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Background:Simple and efficient way of pain management after Coronary Artery Bypass Graft (CABG) surgery is an important aspect of patients' care.Objectives:This study aimed to compare the effects of morphine and diclofenac suppositories on postoperative pain management.Patients and Methods:In this double-blinded clinical trial study, 120 patients aged 30-65 years old, undergone CABG, were equally divided into two groups of A (morphine) and B (diclofenac). All patients were anesthetized with intravenous fentanyl 10 μg/kg, etomidate 0.2 mg/kg and cisatracurium 0.2 mg/kg. Anesthesia was maintained with oxygen 50% and air 50%, propofol 50 μg/kg/min, fentanyl 1-2 μg/kg/h and atracurium 0.6 mg/kg/h. Analgesics were administered after the operation at intensive care unit (ICU) and Visual Analogue Score (VAS) was evaluated in both groups in 4-hour intervals after extubation for 24 hours. After extubation in case of VAS > 3, morphine suppository 10 mg (group A) or diclofenac suppository 50 mg (group B) was administered for patients.Results:No significant statistical relationship was found between the two groups regarding gender, age, BMI, paracetamol consumption, length of operation time, cardiopulmonary bypass pump (CPB) time, and stay time at ICU (P Value ≥ 0.05). Total dosage of used morphine was 22 ± 8.3 mg in each patient and total dosage of used diclofenac was 94 ± 32.01 mg. Average variation of VAS at measured intervals was significant (P Value ≤ 0.0001), but these variations were not significantly different when comparing the two groups (P Value = 0.023).Conclusions:Both morphine and diclofenac suppositories reduced pain significantly and similarly after CABG surgery.

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Section: Discussionmentioning

confidence: 99%

“…Diclofenac can be prescribed as 50-100 mg suppository with the maximum dosage of 150 mg per day in two or three divided doses in adults. Quick absorption through rectum has been shown ( 10 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

Comparing the Effects of Morphine Sulfate and Diclofenac Suppositories on Postoperative Pain in Coronary Artery Bypass Graft Patients

et al. 2014

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“…Stein et al showed that low doses of IA morphine, injected on the completion of arthroscopic knee surgery, can produce postoperative analgesia via activation of local opioid receptors in the knee joint ( 24 ). This peripheral effect of narcotic-like analgesics could explain why the IA administration of morphine and tramadol could provide a satisfactory pain relief state as well as fewer systemic adverse effects ( 25 ). Morphine, as an opioid, and bupivacaine, as a local anesthetic, alone or compound form, are frequently injected into the IA space of the knee joint after arthroscopic surgery ( 26 , 27 ).…”

Section: Discussionmentioning

confidence: 99%

“…We had lower VAS scores, decreased 24-hour total analgesic consumption in local anesthetic administration of tenoxicam-tramadol in comparison with saline group, which was similar to abovementioned studies. Jazayeri et al compared the efficacy of morphine and tramadol on postoperative pain after arthroscopic knee surgery ( 25 ). They had comparable VAS scores between two groups.…”

Section: Discussionmentioning

confidence: 99%

The Analgesic Effects of Morphine and Tramadol Added to Intra-articular Levobupivacaine-Tenoxicam Combination for Arthroscopic Knee Surgery on Postoperative Pain; a Randomized Clinical Trial

Oral¹,

Hanci²,

Sivrikaya

et al. 2015

Anesth Pain Med

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Background:Arthroscopic knee surgery is commonly performed as an outpatient procedure and is often associated with postoperative pain.Objectives:We aimed to compare the effects of intra-articular levobupivacaine-tenoxicam-tramadol and levobupivacaine-tenoxicam-morphine combinations on postoperative pain in patients undergoing elective arthroscopic knee surgery.Materials and Methods:A total of 90 ASA I-II patients undergoing elective arthroscopic meniscectomy under general anesthesia were enrolled. The participants were randomly allocated to three groups to receive the following intra-articular medications after completion of the surgery and before deflation of the tourniquet: Group S, 20 mL of saline; Group T, 35 mg of levobupivacaine, 20 mg of tenoxicam, and 100 mg of tramadol in 20 mL saline; and Group M, 35 mg of levobupivacaine, 20 mg of tenoxicam, and 4 mg of morphine in 20 mL saline. Visual analogue scale values at rest (VASr) and at active flexion of knee (VASa) at postoperation hours 1, 2, 4, 8, 12, and 24, duration of analgesia, total analgesic consumption, and number of rescue analgesia at 24 hours were evaluated.Results:VASr and VASa were significantly higher in group S in comparison to other groups (P < 0.05). Duration of analgesia was significantly longer in Group T and Group M than in Group S (P < 0.05). The difference between group T and group M was also significant (P < 0.05). Number of rescue analgesia and total analgesic consumption at postoperative hour 24 was significantly fewer in group M compared with other groups (P < 0.05).Conclusions:Intra-articular levobupivacaine-tenoxicam-morphine combination provides effective pain relief, longer analgesic duration, and less analgesic requirement when compared with intra-articular levobupivacaine-tenoxicam-tramadol combination and saline after knee arthroscopic surgery.

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“…In one study it was demonstrated that administration of Dextromethorphan prior to abdominal surgery decreased the need for postoperative opioids significantly compared to the placebo group ( 9 ). Also, Dextromethorphan has been successfully used to relieve postoperative pain following mastectomy, hysterectomy, and diagnostic laparoscopy ( 8 , 10 ). Considering the relevant literature, it seems that Dextromethorphan is effective in decreasing postoperative pain in patients and reduces administration of opioids.…”

Section: Introductionmentioning

confidence: 99%

Effects of Preoperative Use of Oral Dextromethorphan on Postoperative Need for Analgesics in Patients With Knee Arthroscopy

et al. 2013

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BackgroundStudies have shown that N-methyl-D-aspartate receptor (NMIDA) plays an essential role in postoperative pain. It seems that use of NMDA receptor antagonists such as Dextromethorphan intensifies the analgesic effects of opioids.ObjectivesIn this study, we evaluated the effect of preoperative administration of Dextromethorphan on postoperative pain reduction.Patients and MethodsThis double blind randomized clinical trial was conducted on arthroscopic surgery candidates. Participants were randomly allocated to interventions and assigned to two groups of Dextromethorphan and placebo. In Dextromethorphan group, the patients received 1 mg/kg Dextromethorphan orally the night before the operation. Pain severity based on the visual analog scale (VAS) up to 16 hours postoperation, use of opioids, and the first request for analgesics were recorded postoperatively.ResultsA total of 112 patients in the Dextromethorphan (n = 54) and placebo groups (n = 58) were evaluated. No significant difference was detected between the two groups for age, sex or ASA. The mean amount of opioid consumption was significantly lower in patients who received Dextromethorphan (10.7 ± 5.6 mg) compared to the placebo group (13.1 ± 5.6 mg), (P = 0.03). The mean time until the first opioid request in patients who received Dextromethorphan was longer than that in the placebo group (P = 0.01).ConclusionsThe study results demonstrated that preemptive use of Dextromethorphan reduced postoperative pain and opioid consumption.

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Comparing the Efficacy of Intra-Articular Application of Morphine and Tramadol on Postoperative Pain After Arthroscopic Knee Surgery

Cited by 8 publications

References 12 publications

Comparing the Effects of Morphine Sulfate and Diclofenac Suppositories on Postoperative Pain in Coronary Artery Bypass Graft Patients

Comparing the Effects of Morphine Sulfate and Diclofenac Suppositories on Postoperative Pain in Coronary Artery Bypass Graft Patients

The Analgesic Effects of Morphine and Tramadol Added to Intra-articular Levobupivacaine-Tenoxicam Combination for Arthroscopic Knee Surgery on Postoperative Pain; a Randomized Clinical Trial

Effects of Preoperative Use of Oral Dextromethorphan on Postoperative Need for Analgesics in Patients With Knee Arthroscopy

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