Intra-articular morphine and clonidine produce comparable analgesia but the combination is not more effective

Gentili, Marc; Houssel, P; Osman, Mahdi; Henel, D; Juhel, A.; Bonnet, Francis

doi:10.1093/bja/79.5.660

Cited by 68 publications

(45 citation statements)

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“…Several studies in the literature have compared the analgesic action of morphine, bupivacaine or their association. Other drugs were also used 28,[33][34][35][36] . Morphine analgesic action is a consequence of its binding to local receptors.…”

Section: Discussionmentioning

confidence: 99%

“…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] . A ação analgésica da morfina é decorrente da ligação desse opióide a receptores locais.…”

Section: Tabela X -Efeitos Colaterais Observados Em Cada Grupounclassified

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

Souza¹,

Issy²,

Sakata³

2002

Rev. Bras. Anestesiol.

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Section: Discussionmentioning

confidence: 99%

Section: Tabela X -Efeitos Colaterais Observados Em Cada Grupounclassified

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

Souza¹,

Issy²,

Sakata³

2002

Rev. Bras. Anestesiol.

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“…All the patients were monitored intra operatively using standardized equipment. Readings of echocardiograph, blood pressure and pulse oximetry at regular time intervals (at 5,15,30,60 and 90 mins or till end of procedure) as well as sensory and motor characteristics of the established block at various intervals (2,4,8,12,24,48 and 72 hours postoperatively) side effects, number of boluses and doses of PCEA, total amount of pain relief medications utilized over the period was observed, VAS scores and time of mobilization and discharge from the hospital were also noted in a pre-designed proforma.…”

Section: Methodsmentioning

confidence: 99%

Intra Articular Administration; To Determine the Analgesic Efficacy of Bupivacaine and Compare It With Levobupivacaine, During Surgical Procedures of the Knee Joint

Raza

Bourazza

Kamlaish

2017

TPMJ

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ABSTRACT… Objectives:The aim of our study is to provide a comparison between levobupivacaine and bupivacaine administered intra articulary in the knee joint during arthroplasty procedures, and compare the postoperative analgesic effects. Method: Study Design: Randomized control trial. Period: One year duration from March 2015 to March 2016. Setting: Tertiary care centre in Karachi, Pakistan. The study population consisted of n= 50 patients belonging to ASA class II and III, who were scheduled to undergo TKA (total knee arthroplasty). The patient population was divided into two groups, group A consisted of all the patients who received bupivacaine, and group B consisted of all the patients who received levobupivacaine. All the patients were between the ages of 18 and 70 years, and had normal joint mobility. After explaining the procedure and taking due informed consent, the patients were informed about the use of the visual analog scale for pain and the patients controlled epidural anesthesia (PCEA). Readings of echocardiograph, blood pressure and pulse oximetry, sensory and motor characteristics of the established block, side effects, number of boluses and doses of PCEA, total amount of pain relief medications utilized over the period, VAS scores and time of mobilization and discharge from the hospital were also noted in a pre-designed. Statistical analysis was done using SPSS version 23. Results: The study population consisted of n= 50 patients. The VAS scores at were found to be lower in the bupivacaine group at 4,8,12 and 24 hours and VAS scores at 48 hour were lower in levobupivacaine group having a p value of less than 0.05, but the VAS scores were similar at the 0,2 and 72 hours in both the groups. The post-operative analgesic requirement was similar for both groups. The sensation of pain at the time of post-operative physiotherapy measure with the VAS score, was also similar in the two groups having a p value of less than 0.05. Similar results were found between the time of discharge and time of mobility, having a p value of less than 0.05. Conclusion: The use of multimodal analgesia with the administration of intra articular local anesthetics combined with PCEA is a very effective method to provide post-operative pain relief in patients undergoing total knee arthroplasty. Key words:Intra articular administration, knee arthroplasty, levobupivacaine, bupivacaine, post-operative analgesia, patient controlled epidural analgesia.

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“…To overcome this, various drugs such as opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), clonidine, neostigmine, and ketamine have been used with variable effects. [3][4][5] Recent evidence suggests that N-methyl-d-aspartate (NMDA) receptors located in the peripheral somatic and visceral pain pathways play an important role in nociception. [6] NMDA receptors have been found in joints as demonstrated in a rat model in a study conducted by Yu et al [7] ORIGINAL ARTICLE Despite recently intra-articular injection of magnesium sulfate had been shown to have post-operative analgesia after arthroscopy, [8] but the effect of magnesium sulfate as a NMDA receptor antagonist intra-articularly in reducing pain sensation, or as an adjunct to the local intra-articular anesthetic, is not known.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Toloueghamari

2017

AJP

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Background and Objective: Intra-articular magnesium sulfate, an N-methyl-d-aspartate receptor blocker, would be of particular interest in either producing post-operative analgesia or enhancing the analgesic effect of intraarticular bupivacaine. This study was aimed to investigate the efficacy of intra-articular magnesium sulfate injection as post-operative analgesic agent knee arthroscopy. A decrease in visual analog scale (VAS) score followed by a decrease in analgesic requirement and subsequently less analgesic requirement. Materials and Methods: This is a randomized, prospective, double-blinded clinical trial conducted on patients undergoing arthroscopic partial meniscectomy referred to Ahvaz Razi Hospital, Iran. 94 patients were randomly divided into two parallel groups. The saline placebo group received 20 ml of isotonic saline, and the magnesium sulfate group received 20 ml of isotonic saline containing 1 g magnesium sulfate. The post-operative analgesia was assessed using VAS recorded at 5, 60, 120, and 240 min post-surgery. Patients were evaluated at rest and under movement. Results: The magnesium sulfate group showed a significant reduction in VAS score, a significantly increased time to first post-operative analgesic request, as well as significantly reduced total analgesic requirement than the control group. Conclusion: Magnesium sulfate produces a reduction in post-operative pain when given intra-articularly in comparison to saline placebo.

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Intra-articular morphine and clonidine produce comparable analgesia but the combination is not more effective

Cited by 68 publications

References 4 publications

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

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

Intra Articular Administration; To Determine the Analgesic Efficacy of Bupivacaine and Compare It With Levobupivacaine, During Surgical Procedures of the Knee Joint

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