Effects of morphine on peri-articular infiltration analgesia in total knee arthroplasty: a prospective, double-blind, randomized controlled trial

Wang, Qiuru; Sun, Jikui; Hu, Yunlian; Zeng, Yan; Hu, Jian; Yang, Jing; Kang, Pengde

doi:10.1007/s00264-020-04700-z

Cited by 19 publications

(27 citation statements)

References 28 publications

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“…The patients in group I also demonstrated the highest active and passive ROM in the rst four days, which was inconsistent with existing studies [14,[17][18][19]. Furthermore, the best 1-min walking abilities on postoperative day 2 and day 4 were observed in group I.…”

Section: Discussioncontrasting

confidence: 80%

“…Patients in group I had the lowest VAS scores in the rst four days after TKA, con rming that the regimen effectively reduced the damaging stimulus and release of in ammatory mediators, prevented pain sensitization and alienation, and achieved balanced analgesia. It was consistent with the results of Garcia et al but inconsistent with the results of Iwakiri et al and Wang et al [14,17,18]; Interestingly, VAS on the rst day after operation in the three groups was lower compared with some similar studies [19]. We believe that it could be due to the use of rescue analgesia and the requirement for patients to perform active knee movement and receive continuous passive movement only within the tolerable range.…”

Section: Discussionsupporting

confidence: 67%

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Morphine and dexamethasone-incorporated cocktail regimen for postoperative pain in patients undergoing primary total knee arthroplasty: a randomized controlled trial

Gong

et al. 2022

Preprint

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Background This study was conducted to evaluate the pain-reducing efficacy and safety of morphine and dexamethasone-incorporated cocktail regimen in patients undergoing total knee arthroplasty (TKA). Methods This study enrolled 213 patients and randomly assigned them to one of three groups. Group I patients were injected with morphine, dexamethasone, bupivacaine, flurbiprofen axetil, and normal saline. Patients in group II were injected with dexamethasone, bupivacaine, flurbiprofen axetil, and normal saline. Patients in control group were administered bupivacaine, flurbiprofen axetil, and normal saline. To compare the pain-controlling efficiency, the visual analog scale (VAS) score, active and passive range of movement (ROM), rescue analgesia use, and 1-min walking distances were recorded and evaluated. Indicators of inflammation include serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) levels, and white blood cells count (WBC) were tested and compared. The following side effects were monitored: headache, dizziness, nausea, vomiting, wound leakage and wound infection. Results Group I patients had the lowest VAS and the highest active and passive ROM. In Group I, the VAS reduced from day one to four, but the ROM increased. Group II patients had a smaller reduction in VAS and a smaller increase in ROM, compared with the patients in control group. Patients in group I required the least rescue analgesia use in the first 48 hours postoperative and demonstrated the best walking abilities on postoperative day 2 and day 4. Indicators of inflammation were similar in all enrolled individuals. Following side effects were not recorded: headache, dizziness, nausea, and vomiting. Wound leakage was observed in four patients in group I (two patients) and group II (two patients). No wound infection symptoms were detected. Conclusions Morphine and dexamethasone-incorporated cocktail regimen efficiently reduced postoperative pain in patients undergoing primary TKA. Trial registration: Randomized controlled trial ISRCTN25027558, registered retrospectively on 27/02/2022. ( https://www.isrctn.com/ISRCTN25027558 )

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Section: Discussioncontrasting

confidence: 80%

Section: Discussionsupporting

confidence: 67%

Morphine and dexamethasone-incorporated cocktail regimen for postoperative pain in patients undergoing primary total knee arthroplasty: a randomized controlled trial

Gong

et al. 2022

Preprint

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“…We published papers dealing with the use of specific molecules like tranexamic acid during surgery [4][5][6][7]. We published also papers related to the use of drugs or medications before or after surgery as well as regional anaesthetic blocks [8][9][10][11]. However, the most read and cited borderline papers are dedicated to pain management and blood loss as well as the outcome studies in controversial subjects [12][13][14][15].…”

mentioning

confidence: 99%

About anesthesiology and surgery: analgesia, anaesthesia, and non-surgical papers published in journals of surgery

Scarlat

Mavrogenis

2021

International Orthopaedics (SICOT)

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Subjects treated in a general orthopaedic publication are innumerable. Some themes could not be included in a very specialized journal or in a technical publication because they treat "borderline" subjects such as the biology of healing in tissues, patient-related outcomes in a specific procedure, or pain management. Other papers that have a difficulty in finding a place are participation of vitamins or regimes in healing, education in preparation of patients for a specialized procedure such as joint replacement, and doctor's experience in introducing new procedures.We published many such controversial subjects related to orthopaedics and conjunctive tissue [1-3]. We published papers dealing with the use of specific molecules like tranexamic acid during surgery [4][5][6][7]. We published also papers related to the use of drugs or medications before or after surgery as well as regional anaesthetic blocks [8][9][10][11]. However, the most read and cited borderline papers are dedicated to pain management and blood loss as well as the outcome studies in controversial subjects [12][13][14][15]. Some of the published papers were dedicated to analgesia and anaesthesia. For millennia, pain was a major subject for both patients and doctors and modern anaesthesia realized unbelievable progress in managing pre-operative and postoperative care as well as the realization of surgery "per se" [16,17]. No surgery without anaesthesia. The surgical team includes as pre-requisite the presence of a specialized anesthesiologist doctor or assistant. Difficult cases are managed correctly with pre-operative and post-operative protocols. Many patients are old, presenting comorbidities and chronic treatments such as anticoagulants or respiratory medication. Patients become more and more demanding and the cases become more complex and difficult. Is it reasonable to refuse

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“…It has been suggested that systemic administration of opioids also produce large proportion of its acute analgesic effect by binding on peripheral opioid receptors. Hence, periarticular local anesthetic cocktails including morphine may increase analgesic efficacy of opioids by avoiding opioid related systemic side effects [27,28]. We use the combination of morphine and local anesthetic without adding steroid or nonsteroidal anti-inflammatory agent in periarticular injection cocktail with intravenous dexamethasone to prolong analgesic effect of local anesthetics with assumption of reduction in opioid related side effects that may be seen after intravenous consumption [29].…”

Section: Discussionmentioning

confidence: 99%

Comparison of iPACK and periarticular block with adductor block alone after total knee arthroplasty: a randomized clinical trial

Korkusuz²,

Başaran

et al. 2022

J Anesth

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PurposeThe infiltration between the popliteal artery and the capsule of the posterior knee (iPACK) has been described to provide analgesia without loss of muscle strength and is effective in functional recovery. This study compared iPACK + ACB (adductor canal block) with PAI (periarticular infiltration) + ACB and ACB alone in terms of postoperative analgesia and functional improvement. Methods This double-blinded randomized controlled trial included 105 patients undergoing unilateral total knee arthroplasty. Patients received ACB, iPACK + ACB, and PAI + ACB along with spinal anesthesia. The primary outcome was the area under the curve (AUC) numeric rating scale (NRS) at 48 h. Secondary outcomes were cumulative postoperative analgesic consumption within 48 h, timed up-and-go test, range of motion, length of hospital stay, patient satisfaction, and adverse events. ResultsThe 48-h AUC movement NRS score in the iPACK + ACB group was significantly lower than in the PAI + ACB and ACB groups (p < 0.05). At the postoperative 48th h, the opioid consumption of the iPACK + ACB group was lower than those of the ACB and PAI + ACB groups (p < 0.001). The patients in the iPACK + ACB group had significantly shorter discharge and mobilization days than the ACB and PAI + ACB groups (p < 0.001). Conclusions The adding of an iPACK block to the ACB improves postoperative analgesia and reduces opioid consumption. In addition, this approach improves functional performance and reduces hospital stay.

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Effects of morphine on peri-articular infiltration analgesia in total knee arthroplasty: a prospective, double-blind, randomized controlled trial

Cited by 19 publications

References 28 publications

Morphine and dexamethasone-incorporated cocktail regimen for postoperative pain in patients undergoing primary total knee arthroplasty: a randomized controlled trial

Morphine and dexamethasone-incorporated cocktail regimen for postoperative pain in patients undergoing primary total knee arthroplasty: a randomized controlled trial

About anesthesiology and surgery: analgesia, anaesthesia, and non-surgical papers published in journals of surgery

Comparison of iPACK and periarticular block with adductor block alone after total knee arthroplasty: a randomized clinical trial

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