The Effect of Tourniquet Release Time on the Analgesic Efficacy of Intraarticular Morphine After Arthroscopic Knee Surgery

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

“…Some studies have shown a correlation between tourniquet maintenance time and analgesic efficacy of intra-articular drugs. Others have suggested that the tourniquet should remain for at least 10 minutes after intra-articular injection 25,30 . A study has shown that the speed of opioids absorption in the joint is an important factor 5 .…”

“…Some studies, however, had better analgesic effects with morphine [24][25][26] and others with bupivacaine 14,9,10,16,17 . Some studies using alone morphine have shown favourable results 15,22,30 . In our study, there has been no difference in analgesic efficacy among bupivacaine, morphine and fentanyl in almost all investigated moments.…”

“…Alguns estudos demonstraram correlação entre o tempo de manutenção do garrote e a eficácia analgésica das drogas utilizadas por via intra-articular. Outros sugeriram que o garrote deveria permanecer por pelo menos 10 minutos após a injeção intra-articular 25,30 . Estudo mostra que a velocidade de absorção dos opióides a partir da articulação é um fator importante 5 .…”

“…Entretanto, alguns trabalhos obtiveram melhor efeito analgésico com a morfina [24][25][26] e outros com a bupivacaína 4,9,10, 16,17 . Alguns estudos utilizando a morfina isoladamente obtiveram resultados favoráveis 15,22,30 . No presente estudo, não houve diferença na eficácia analgé-sica entre a bupivacaína, morfina, e fentanil, na maioria dos tempos investigados.…”

Eficácia analgésica do uso de dose alta de morfina intra-articular em pacientes submetidos à artroplastia total de joelho

“…A significant reduction in pain and analgesic consumption, besides an increase in the time until the request of the first dose of rescue analgesic, was observed in the first group. The author attributed this phenomenon to the removal of morphine from its receptors due to an increase in local blood flow secondary to post-ischemic reperfusion with the early release of the tourniquet 21 .…”