Intra-Articular Morphine for Pain Relief After Anterior Cruciate Ligament Repair

Joshi, Girish P.; McCarroll, S. M.; Brady, O.; Hurson, B.; Walsh, G.

doi:10.1093/bja/70.1.87

Cited by 92 publications

(69 citation statements)

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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%

Analgesic effect of intra‐articular morphine after arthroscopic meniscectomy

et al. 1994

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Section: Discussionmentioning

confidence: 99%

Analgesic effect of intra‐articular morphine after arthroscopic meniscectomy

et al. 1994

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“…Bezieht man die ersteren 9 in die Bilanz mit ein, so kommen 7mal "pro" und 2mal "contra" hinzu und es steht 20,5 zu 10,5. [4,6,9,13,20,21,22,23,24,26,34,35,47] ("pro" in Tab. 1), 8 fanden keinen signifikanten Effekt gegen Plazebo [1,3,11,14,15,39,44,53] ("con" in Tabelle …”

Section: Zusammenfassungunclassified

“…Sie weisen ferner darauf hin, daß die bisherige Literatur von einer Eignung der PCA-Methode zur Evaluation der Wirksamkeit anderer Analgesieverfahren ausgehe. Auch JOSHI et al haben PCA-Pumpen zur Schmerzevaluation eingesetzt und damit einen Opioideffekt gefunden [23]. In ihrer Studie betrug der durchschnittliche Morphinverbrauch über 24 h in der Plazebogruppe 74 mg (!…”

Section: Kein Effekt Nach Leitungsblockaden?unclassified

“…Einige nannten jedoch die Erfordernis der Anlage einer intraartikulären Drainage als Ausschlußkriterium für die Teilnahme an der Studie [4,6,18,47,48]. Außerdem ist davon auszugehen, daß bei ambulanten Operationen [1-3, 20, 16, 25, 29, 30, 31, 34, 38 [23]. KARLSSON et al, in deren Studie Kreuzbandplastiken arthroskopisch operiert worden waren, schlossen Drainagen aus.…”

Section: Abfließen üBer Die Saugdrainage?unclassified

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Klinische Studien zur peripheren Wirksamkeit von Opioiden nach Kniegelenk-Operationen

Meiser

Laubenthal

1997

Der Anaesthesist

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In this article 34 randomized controlled trials examining peripherally mediated opioid effects after knee surgery are discussed. All studies examined small doses of morphine injected intraarticularly at the end of knee surgery, but not all studies did show an analgesic effect of the peripheral opioid. Because of differing study designs a meta-analysis of the data is not possible. Some important factors like those that the respective authors try to explain the contradictory results with are discussed here: The used concentrations, volumes and doses of morphine are not of major importance. An addition of adrenaline to the study drug, as well as the use of a tourniquet and the time interval between the intra-articular injection and tourniquet release do not seem crucial either. The use of intra-articular drainage (which is opened 10 min after injection of the study drug) and of patient-controlled analgesia as an evaluative method also do not seem to play a major role. But it is remarcable that peripheral opioid effects have often been described after general and local anesthesia but only once after regional anaesthesia. It may be that the activation or expression of peripheral opioid receptors is inhibited by the blockade of input to the central nervous system. Animal experiments are needed to clarify this issue. But it may also be that postoperative pain after regional anaesthesia does not reach a level high enough to make an analgesic effect measurable. If patients after regional anesthesia are not considered, 20 studies out of 29 were able to demonstrate opioid effects whereas 9 were not: The work of Heard and coll. as well as Ruwe and coll. must be criticized because of methodological shortcomings. In the remaining 7 studies the patients of the comparative groups only show low pain scores which may make it impossible to measure an analgesic effect by intraarticular morphine. In summary it can be concluded that very small doses of morphine injected intra-articularly after knee surgery do exert an analgesic effect. In some studies this effect lasted even up to 48 h. But at least during the first two hours the effect is small or else doubtfull. Therefore a combination with bupivacain, a local anesthetic which acts rapidly but only for some hours can be recommended. Most authors testing this combination found it most useful.

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“…These cytokines have a fundamental role in RA pathology, causing inflammation, pain and articular destruction (9). Previous studies have indicated that injection of opioids into knee joints after surgery caused prolonged post-operative analgesia in patients (10)(11)(12), which may be associated with their immunomodulatory function. Based on these results, the present study hypothesized that opioids also produce analgesic effects on RA via regulating peripheral inflammation.…”

Section: Introductionmentioning

confidence: 99%

β-Endorphin attenuates collagen-induced arthritis partially by inhibiting peripheral pro-inflammatory mediators

Huang

Qiu

et al. 2018

Exp Ther Med

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Abstract. The classical analgesic pathway of opioids by binding their receptors in the nervous system is well known. However, little is known regarding opioid analgesia through the anti-inflammatory pathway. The present study aimed to investigate the analgesic and anti-inflammatory effect of β-endorphin on inflammatory pain. A rat model of collagen-induced arthritis (CIA) was generated by intradermal injection of bovine type II collagen. Rats were divided into the CIA + saline group and the CIA + β-endorphin group, in which rats were intraperitoneally injected with β-endorphin once every other day from day 18 following the injection of CII until day 28. Thermal hyperalgesia as determined by tail flick latency (TFL), as well as paw arthritis index and swelling. Tumor necrosis factor (TNF)-α, interleukin (IL)-1β and IL-6 mRNA expression in synovial tissue and their protein levels in paw inflammatory tissue were measured. The rat CIA model was successfully induced as indicated by the significantly decreased TFL, increased paw arthritis index and percentage of swelling on day 18. β-endorphin treatment significantly increased the TFL, while decreasing the paw arthritis index and swelling in CIA rats. It also significantly downregulated TNF-α and IL-1β mRNA expression in synovial tissue and their protein levels in inflammatory tissue of the paws of CIA rats, while it had no significant effect on the levels of IL-6. These results indicated that β-endorphin suppresses peripheral pro-inflammatory mediators in collagen-induced arthritis, which may contribute to its analgesic effect. IntroductionThe analgesic effect of opioids has been well demonstrated in animal behavioral studies as well as human clinical trials (1,2). Opioids are potent analgesics, which exert their pharmacological effects by binding and activating specific receptors in the nervous system (3,4). Accumulating evidence has demonstrated that opioids also exert an immunomodulatory function (5). Under inflammatory conditions, local inflammatory cells, including monocytes, granulocytes, lymphocytes and macrophages, synthesize and release opioids (6). Opioids also bind to receptors on immune cells to regulate inflammatory cytokines, which may constitute another mechanism of opioid-induced analgesia (7).Rheumatoid arthritis (RA) is a chronic, systemic type of autoimmune inflammatory arthritis, which may lead to severe joint pain, as well as destruction of cartilage and bone (8). A large number of cytokines, including interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α are active in the joints of patients with RA. These cytokines have a fundamental role in RA pathology, causing inflammation, pain and articular destruction (9). Previous studies have indicated that injection of opioids into knee joints after surgery caused prolonged post-operative analgesia in patients (10-12), which may be associated with their immunomodulatory function. Based on these results, the present study hypothesized that opioids also produce analgesic effects on RA via regulating...

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Intra-Articular Morphine for Pain Relief After Anterior Cruciate Ligament Repair

Cited by 92 publications

References 0 publications

Analgesic effect of intra‐articular morphine after arthroscopic meniscectomy

Analgesic effect of intra‐articular morphine after arthroscopic meniscectomy

Klinische Studien zur peripheren Wirksamkeit von Opioiden nach Kniegelenk-Operationen

β-Endorphin attenuates collagen-induced arthritis partially by inhibiting peripheral pro-inflammatory mediators

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