Intra-articular morphine after arthroscopic knee operation

Abstract

Reports on pain relief with intra-articular morphine after arthroscopic knee operation are conflicting. To assess the long-term antinociceptive effect of intraarticular morphine, we studied pain at rest, pain on standing and ability to walk for 7 days after intraarticular injection of bupivacaine 100 mg (group 1, n = 11), bupivacaine 100 mg and morphine 1 mg (group 2, n = 10) and bupivacaine 100 mg and morphine 3 mg (group 3, n = 10) at the end of operation. Pain and walking were assessed by visual analogue and walking scales, respectively. Pain was treated with morphine i.v. in the recovery room and Tylenol No. 3 after discharge. Assessments were made before operation, and 1, 3, 6 and 12 h after injection and on days 1-7 after operation. There were significant differences between the groups in pain scores (pain at rest, P < 0.05; pain on standing, P < 0.01). The pain scores in group 3 were lower than those in group 1. The differences in pain scores at rest were significant at 12 h and on day 1 after operation and differences in pain scores on standing were significant at 12 h and on days 1 and 2 after operation. The scores in group 2 were intermediate between those in groups 1 and 3. The walking scores in group 3 were significantly better than those in group 1 at 12 h. The amount of analgesics received in groups 2 and 3 was significantly less than that in group 1 until day 3 after operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Analgesia intra-articular com morfina, bupivacaína ou fentanil após operação de joelho por videoartroscopia

“…Another possibility is spinal anesthesia preemptive effect, preventing medullary neurons sensitization and providing adequate postoperative analgesia. It is to be stressed that in studies where there have been analgesic effects with different intra-articular drugs, general anesthesia was the technique of choice 10,13,21,[23][24][25][26][27][28] . It must be taken into consideration that surgical procedures performed could be responsible for a less severe nociceptors stimulation.…”

“…However, most protocols allowed for the use of perioperative opioids, especially fentanyl, and few studies avoided the use of such agents with preemptive effects 25,27,32 . Several studies in the literature have compared the analgesic action of morphine, bupivacaine or their association.…”

“…Outra possibilidade é o efeito preemptivo da anestesia subaracnói-dea, que impede a sensibilização de neurônios medulares e proporciona analgesia pós-operatória adequada. Ressalta-se que, nos trabalhos em que houve efeito analgé-sico com diferentes fármacos por via intra-articular, foi empregada anestesia geral 10,13,21,[23][24][25][26][27][28] . Deve ser levado em consideração que os procedimentos cirúrgicos que foram realizados poderiam ser responsáveis pela estimulação pouco intensa dos nociceptores.…”

“…Os primeiros estudos sobre a eficácia analgésica da morfina por via intra-articular foram realizados sob anestesia geral. Porém, a maioria dos protocolos permitiu o uso de opióides, principalmente o fentanil, no per-operatório, e poucos foram os trabalhos que evitaram o uso desses agentes que possuem efeito preemptivo 25,27,32 .Diversos trabalhos disponíveis na literatura compararam ação analgésica da bupivacaína, da morfina e da associação desses agentes. Outros fármacos também foram utilizados 28,[33][34][35][36] .…”

Comparison of Effect of Intraarticularly Delivered Levobupivacaine Morphine and Tramadol Combinations on Postoperative Analgesia Following Arthroscopic Knee Surgery

“…Preoperatif ve peroperatif medikasyonda herhangi bir opioid kullanılması sonuçları etkileyebilmektedir (22,(25)(26)(27) Yapılan çalışmalarda operasyonda uygulanan prosedürün tipi ile postoperatif ağrı yakınması ve operasyon süresi ile postoperatif ağrı şiddeti arasında korelasyon olduğu gösterilmiştir (22,31). Bu nedenle çalışmamızda cerrahi prosedürün tipi diagnostik artroskopi, menisektomi gibi günübirlik cerrahi olguları ile sınırlandırılmış olup ön çapraz bağ rekonstrüksiyonu gibi uzun süreli cerrahi girişimler çalışma kapsamı dışında bırakılmıştır.…”