Intra-articular morphine for pain relief after knee arthroscopy

Joshi, Girish P.; McCarroll, S. M.; Cooney, C.; Blunnie, W. P.; OʼBrien, Timothy M.; Lawrence, Andrew J.

doi:10.1302/0301-620x.74b5.1527127

Cited by 156 publications

(75 citation statements)

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“…Stein et al showed that low doses of intra-articular morphine (standard formulation) reduced pain after knee surgery by an action specific to local intra-articular receptors [ 11; consumption of supplemental postoperative analgesics was also shown to be significantly reduced. These findings were confirmed by Joshi et al [2]. However, in a more recent study, Raja et al found no evidence for the peripheral action of morphine, paradoxically finding that it was associated with higher pain scores than saline or bupivacaine during the first 2 h following arthroscopy [3].…”

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confidence: 81%

Intra‐articular morphine and bupivacaine analgesia after arthroscopic knee surgery

et al. 1994

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Summary We assessed the effectiveness of intra‐articular solutions of morphine, bupivacaine with adrenaline and a combination of both, compared with placebo in facilitating mobilisation and reducing postoperative pain and analgesic requirements for 24 h after operation. Forty patients undergoing arthroscopic knee surgery were studied in a double‐blind, randomised, controlled trial. All treatments proved more effective than placebo in facilitating earlier mobilisation and in decreasing postoperative pain as measured by visual analogue scale. Morphine alone provided the best analgesia and significantly decreased analgesic consumption for 24 h after surgery. We conclude that 1 mg of intra‐articular morphine provides effective pain relief following arthroscopic knee surgery and that the addition of bupivacaine is of no benefit.

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mentioning

confidence: 81%

Intra‐articular morphine and bupivacaine analgesia after arthroscopic knee surgery

et al. 1994

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“…This may explain why some studies with regional or local anaesthesia have failed to show the effect of IA morphine, (29)(30)(31) whereas patients operated under general anaesthesia have demonstrated profound effect of IA morphine. (4,15,32,33) In the current study, spinal anasthesia with bupivacaine was applied. No use of local anaesthetics into the intraarticular space eliminates its possible negative effect on morphine analgesia in our study.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Effectiveness of Three Routes of Morphine in Arthroscopic Knee Surgery

Atım¹,

Sızlan²,

Ergin³

et al. 2011

J Turk Anaesth Int Care

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SUMMARY Aim:The aim of this study was to investigate postoperative analgesic effectiveness of intraarticular (IA), intramuscular (IM) or intrathecal (IT) administration of morphine in arthroscopic knee surgery.Materials and Methods: Seventy-six patients with ASA physical status I-II, aged 18 to 65 years, undergoing arthroscopic knee surgery were included in the study. Morphine (10 mg) was given via IA and IM in groups IA (n:21) and IM (n:16), respectively, at the end of the surgical procedure. IT 0.1 mg morphine was administered together with the local anesthetic in Group IT (n:21). Morphine was not applied to 18 control patients (Group C). Visual analogue scale scores for pain were analyzed. Additional analgesic requirement, side effects of morphine and hemodynamic parameters were compared between the groups.Results: None of the patients in Group IT needed additional analgesic treatment in the first 24 hours, whereas 14.3 %, 25.0 % and 72.2 % of the patients needed additional analgesic administration in the groups IA, IM and C, respectively (p<0.001). There was no difference in nausea or vomiting between groups (p=0.07). Fifteen patients in Group IT and 3 patients in Group IA experienced itching.Conclusion: Morphine in three administration routes provides similar analgesic effect and better analgesia in comparison to the control group. Due to the higher incidence of side effects in the IT group, either IA or IM route may be chosen for an adequate postoperative analgesia at the dose used in the present study. Gereç ve Yöntem: Artroskopik diz cerrahisi uygulanacak 18-65 yaş arası 76 ASA I-II hasta çalışmaya alındı. İA (n:21) ve İM (n:16) grubunda cerrahi işlemin sonunda morfin 10 mg İA ve 10 mg İM yolla, İT (n:21) grubunda ise 0.1 mg morfin lokal anestezikle birlikte İT yolla verildi. Kontrol grubuna (Grup C,n:18) morfin verilmedi. Ağrı görsel analog skalası ile değerlendirildi. Gruplar ek analjezik gereksinimi, morfinin yan etkileri ve hemodinamik parametreler açısın-dan karşılaştırıldı.Bulgular: İlk 24 saatte IT gruptaki hiçbir hastada ek analjezik gereksinimi olmadı. Buna karşılık İA, İM ve C grubunda sırasıyla % 14.3, % 25.0 ve % 72.2 oranlarında ek lornoksikam gereksinimi oldu (p<0.001). Gruplar arasında bulantı ve kusma açısından anlamlı fark bulunamadı (p=0.07). IT grubundan 15 hastada, IA grubundan da 3 hastada kaşıntı gözlendi.Sonuç: Kontrol grubuyla karşılaştırıldığında İA, İM ve İT uygulanan morfinin daha iyi analjezik etki sağladığı gözlendi. Morfinin kullanılan dozlarında İT grubunda daha yüksek yan etki insidansı oluşturması nedeniyle, benzer şekilde yeterli postoperatif analjezi sağlayan İA ya da İM uygulama yolu tercih edilebilir.

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“…In four studies, IA morphine 5 mg in 25 ml of saline resulted in a significant reduction in postoperative pain for up to 24 h after various arthroscopic procedures [4,5] and after anterior cruciate ligament repair [6,7]. In none of these studies was a control for systemic effects of the locally administered morphine included .…”

Section: Discussionmentioning

confidence: 99%

“…Pre-oxygenation replaces alveolar nitrogen with oxygen, ing systems [ 1-31, Four maximal deep breaths with a circle allowing a much longer period before hypoxaemia occurs breathing system produce a comparable degree of preduring the apnoeic period following induction of anaesoxygenation [4,5] when arterial oxygen tension or end-tidal thesia. Many studies since the 1950s have demonstrated oxygen concentration has been measured.…”

Section: Discussionmentioning

confidence: 99%