Postoperative Analgesia for Outpatient Arthroscopic Knee Surgery with Intraarticular Clonidine and/or Morphine

Abstract

Both clonidine, an alpha(2) agonist, and morphine, an opioid agonist, provide enhanced patient analgesia after arthroscopic knee surgery when administered via the intraarticular (IA) route. Clonidine potentiates morphine analgesia in the animal model. We designed this study to determine whether clonidine or morphine results in better analgesia and whether their combination would provide superior analgesia to either drug alone. We evaluated 60 patients undergoing arthroscopic knee meniscus repair under local anesthesia with sedation. After surgery, patients were randomized into four IA groups: Group B received 30 mL 0.25% bupivacaine; Group BC received 30 mL 0.25% bupivacaine and clonidine 1 microg/kg; Group BM received 30 mL 0.25% bupivacaine and morphine 3 mg; and Group BCM received 30 mL 0.25% bupivacaine, clonidine 1 microg/kg, and morphine 3 mg. This study revealed a significant benefit from the individual IA administration of both clonidine and morphine. The combination of these drugs resulted in decreased postoperative pain and analgesic use, as well as an increased analgesic duration compared with either drug alone. We conclude that IA clonidine and morphine improved comfort compared with either drug alone in patients undergoing knee arthroscopy.

Intra-articular administration of lidocaine plus adrenaline in dogs: Pharmacokinetic profile and evaluation of toxicity in vivo and in vitro

“…In humans undergoing arthroscopy, the relief of pain using intra-articular (IA) administration of  2 -agonists, opioids and local anaesthetics has been highly successful (Joshi et al, 2000;Elhakim et al, 1999). In particular, there are reports in the literature that effective analgesia follows an IA administration of lidocaine (Dahl et al, 1990;Arai et al, 2005).…”

Evaluation of the Effective Drugs for the Prevention of Nausea and Vomiting Induced by Morphine Used for Postoperative Pain: A Quantitative Systematic Review

“…Morphine, a narcotic analgesic, is used frequently and administered intravenously, 1) epidurally, 2) subarachnoidally, 3) subcutaneously, 4) and intramuscularly. 5) Continuous intravenous injection of morphine by patient-controlled analgesia (PCA) is often used in many countries and rated favorably.…”

Intra-articular dexmedetomidine with bupivacaine versus bupivacaine alone for postoperative analgesia after knee arthroscopy

“…In another study by Joshi and colleagues, 27 the mean time to first analgesic request after knee arthroscopy was 280 min after IA bupivacaine, 600 min after IA clonidine, 720 min after IA bupivacaine and morphine and 950 min after combined IA clonidine, bupivacaine and morphine. Al-Metwalli et al 5 concluded that IA dexmedetomidine alone provided around 312 min mean time of postoperative analgesia after knee arthroscopy.…”