Evidence for analgesia mediated by peripheral opioid receptors in inflamed synovial tissue

Lawrence, Andrew J.; Joshi, Girish P.; Michalkiewiczi, A.; Blunnie, W. P.; Moriarty, D. C.

doi:10.1007/bf02220608

Cited by 89 publications

(42 citation statements)

References 22 publications

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“…On the other hand, we found neostigmine and clonidine more effective than tenoxicam, supporting Buerkle et al [14] who had reported that, despite the similarities between opioid and muscarinic analgesia, the analgesic efficacy of neostigmine was not altered by inflammation. Intraarticularly administered opoids produce analgesia by binding peripheral opioid receptors which have been found in synovial biopsies from knee joint [2,22]. The most popular opioid for i.a route is morphine, which provides dose-and time-dependent analgesia [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

Intraarticular analgesia after arthroscopic knee surgery: comparison of neostigmine, clonidine, tenoxicam, morphine and bupivacaine

Alagöl

Calpur

Usar

et al. 2005

Knee Surg Sports Traumatol Arthrosc

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We conducted a randomized, placebo-controlled, double blinded study to compare the analgesic effects of intraarticular neostigmine, morphine, tenoxicam, clonidine and bupivacaine in 150 patients undergoing arthroscopic knee surgery. General anaesthesia protocol was same in all patients. At the end of the surgical procedure, patients were randomized into six intraarticular groups equally. Group N received 500 mug neostigmine, Group M received 2 mg morphine, Group T received 20 mg tenoxicam, Group C received 1 microg kg(-1) clonidine, Group B received 100 mg bupivacaine and Group S received saline 20 ml. Visual analog scale scores 0, 30 and 60 min and 2, 4, 6, 12, 24, 48 and 72 h, time to first analgesic need, analgesic consumption at 48 h and 72 h and side effects were noted. Demographic and operational parameters were similar in six groups. All study groups provided analgesia when compared with saline group (P<0.05). Duration of analgesia in Group N and C was longer than other groups (P<0.001). Analgesic consumptions of Group N, C and T were lower than other groups (P<0.01). Pain scores during 2 h postoperatively were lower in all study groups than the control group (P<0.001). In Group B, median pain scores were higher than Groups N and C at 0 min and 30 min postoperatively (P<0.001). Side effects were not significantly different among the six groups. We conclude that the most effective drugs that are administered intraarticularly are neostigmine and clonidine among the five drugs we studied. Tenoxicam provided longer analgesia when compared with morphine and bupivacaine, postoperatively.

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Section: Discussionmentioning

confidence: 99%

Intraarticular analgesia after arthroscopic knee surgery: comparison of neostigmine, clonidine, tenoxicam, morphine and bupivacaine

Alagöl

Calpur

Usar

et al. 2005

Knee Surg Sports Traumatol Arthrosc

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“…However, 60% of 5 mg preoperative morphine patients and 50% of 5 mg postoperative patients did not require any postoperative analgesic [22] in a clinical study, in which low doses of intra-articular morphine provided better pain control than systemic morphine administration, and this effect was reversible by administering the intra-articular opioid antagonist naloxone. The existence of opioid receptors has been demonstrated in synovial biopsies [15].…”

Section: Discussionmentioning

confidence: 99%

Pre- and postoperative intra-articular analgesia for arthroscopic surgery of the knee and arthroscopy-assisted anterior cruciate ligament reconstruction

Denti

Randelli

Bigoni

et al. 1997

Knee Surgery, Sports Traumatology, Arthroscopy

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We tested the effectiveness of different intra-articular analgesics and of pre-emptive intra-articular analgesia for arthroscopy-assisted anterior cruciate ligament reconstruction (ACLR) and for operative knee arthroscopy. Eighty-two patients underwent operative knee arthroscopy under selective subarachnoid anaesthesia (group A), and 60 patients underwent arthroscopy-assisted ACLR under general anaesthesia (group B). Patients were randomly assigned to intra-articular analgesic treatment as follows. Group A: 1, morphine 2 mg; 2, preoperative morphine 2 mg; 3, morphine 5 mg; 4, preoperative morphine 5 mg; 5, bupivacaine 0.25% 20 ml; 6, bupivacaine 0.25% 20 ml + morphine 2 mg; 7, saline solution 20 ml. Group B: 1, morphine 2 mg; 2, morphine 5 mg; 3, preoperative morphine 5 mg; 4, bupivacaine 0.25% 20 ml; 5, bupivacaine 0.25% 20 ml + morphine 2 mg; 6, saline solution 20 ml. All opioids were diluted in 20 ml of saline solution. After postoperative administration the tourniquet was left in place for 10 min. After preoperative administration the intra-articular surgical procedure was delayed for about 5-10 min. In the postoperative period we recorded: total consumption of ketoprofen given i.v. on demand as rescue analgesic treatment; pain scores before surgery and at 1st, 3rd, 6th, 12th and 24th h; occurrence of local anaesthetic or opioid side-effects. Group A (operative knee arthroscopy): all morphine groups (A1, A2, A3, A4) and the bupivacaine group (A5) did not require ketoprofen postoperatively (P < 0.01 vs both groups A6 and A7). Pain scores did not differ significantly among groups. The percentage of patients reporting higher pain scores than before surgery was larger in control group A7 and in bupivacaine groups A5, A6 (83%, 40%, 60%, respectively) and lower in morphine groups A1, A2, A3, A4 (25%, 16%, 27%, 23%, respectively). Group B (ACLR): total consumption of ketoprofen was lowest in groups B2 and B3 (P < 0.001 vs all other treatments and vs control group). The percentage of patients who did not require any rescue analgesic was 60% in group B3, 50% in group B2, 32% in group B5 and 0% in all other groups. No-side effects occurred in any patient. Intra-articular analgesia is safe and effective for arthroscopic knee surgery. Morphine provides a better pain control both in operative knee arthroscopy patients and in ACLR. A 2 mg dose is adequate for operative knee arthroscopy but not for ACLR, where higher dosages are required (5 mg). Pre-emptive intra-articular morphine provides better analgesia than postoperative administration.

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“…Further studies have demonstrated anti-inflammatory effects Lindegaard et al, 2010b) and a lack of local tissue toxicity (Todhunter et al, 1996;Tulamo et al, 1996;Jaureguito et al, 2002). After intra-articular injec-PERIPHERAL PAIN INHIBITION tion, morphine was detectable in synovial fluid for up to 24 h but did not reach clinically significant concentrations in the systemic circulation (Lawrence et al, 1992;Tulamo et al, 1996;Richardson et al, 1997;Brandsson et al, 2000;Lindegaard et al, 2010a).…”

Section: A Treatment Of Pain and Inflammationmentioning

confidence: 99%

Modulation of Peripheral Sensory Neurons by the Immune System: Implications for Pain Therapy

2011

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Evidence for analgesia mediated by peripheral opioid receptors in inflamed synovial tissue

Cited by 89 publications

References 22 publications

Intraarticular analgesia after arthroscopic knee surgery: comparison of neostigmine, clonidine, tenoxicam, morphine and bupivacaine

Intraarticular analgesia after arthroscopic knee surgery: comparison of neostigmine, clonidine, tenoxicam, morphine and bupivacaine

Pre- and postoperative intra-articular analgesia for arthroscopic surgery of the knee and arthroscopy-assisted anterior cruciate ligament reconstruction

Modulation of Peripheral Sensory Neurons by the Immune System: Implications for Pain Therapy

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