Analgesia with intra-articular morphine after arthroscopic procedures

A.M. Munteanu, D. Anastase, S. Cionac, G. Porumbac
Spitalul Clinic de Ortopedie Foişor

Abstract

The analgesic effect of intra-articular morphine is controversial. We evaluated the efficacy of intra-articular morphine in the prevention of postoperative pain after day-case arthroscopic procedures performed under spinal anesthesia. Sixty five patients undergoing arthroscopic surgery were randomly assigned to receive, at the conclusion of surgery and 5 -10 minutes before tourniquet deflation, either intra-articular (IA) morphine sulphate 2 mg in 10 ml saline (group M, n=35), or IA saline 10 ml (group Control, n=30). Study medication was administered in a double-blinded fashion. Time from IA injection to the first analgesic request (analgesic duration), visual analog score (VAS) at 1, 2, 3 and 6 hours after recovery from motor block and analgesic consumption were recorded by a separate blinded observer. Although a majority of the patients had mild pain throughout the study, thus possibly compromising study sensitivity, pain levels at rest were significantly lower in group M at 1 and 2 hours compared with group C. IA morphine significantly reduced the proportion of patients requiring rescue analgesia (74% of the patients in group M required no analgesic vs. 47% in the control group, p< 0.05). Time to rescue analgesic (analgesic duration) was significantly longer in group M (272+144 vs. 213+70 minutes in the Control group, p<0.05). We conclude that intra-articular morphine is a simple, effective, safe and well-tolerated analgesic technique for outpatients undergoing simple arthroscopic procedures. We hypothesized that a more painful arthroscopic surgical procedure could have elicited a more significant difference in analgesic efficacy.

Keywords: pain, postoperative analgesia, intra-articular drug-therapy

Analgezia cu morfină administrată intraarticular după artroscopia de genunchi

Jurnalul Român de Anestezie Terapie intensivă 2005 Vol.12 Nr.2, 125-128