Comparison of postoperative analgesic effects of intraarticular bupivacaine and morphine following arthroscopic knee surgery

Srinivasa Naga Raja, R. E. Dickstein, C. A. Johnson

Research output: Contribution to journalArticle

Abstract

Recent studies have shown that, in the presence of inflammation, the local administration of opioids results in analgesia. The analgesic efficacy of local anesthetics and morphine administered intraarticularly was compared in patients undergoing arthroscopic knee surgery under epidural anesthesia. We compared postoperative pain scores (VAS) and opioid requirements among 47 patients receiving, in a randomized, double-blinded fashion, one of three intraarticular medications (20 ml): normal saline with 100 μg epinephrine (group 1, n = 16); 0.25% bupivacaine with 100 μg epinephrine (group 2, n = 15); and 3 mg morphine sulfate and 100 μg epinephrine in normal saline (group 3, n = 16). VAS scores were similar in the groups preoperatively and on arrival in the recovery room. At the end of the first postoperative hour, the residual sensory blockade was minimal in all three groups (mean = 3.8- 4.1 segments) and almost total recovery occurred in all three groups before the second postoperative hour. The VAS in group 3 was not significantly different than group 1 at any time interval. Intraarticular bupivacaine (group 2) provided significantly better analgesia than did saline or morphine (group 1 or 3) in the first 2 postoperative hours (ANOVA, P <.05). Subsequent VAS scores were not significantly different in the three groups. While no patient in group 2 requested analgesics during the first postoperative hour, nine patients in group 3 required systemic analgesics (P <.01). We conclude that no evidence for a peripheral opiate-receptor mediated analgesia could be demonstrated in patients undergoing arthroscopic knee surgery under epidural anesthesia.

Original languageEnglish (US)
Pages (from-to)1143-1147
Number of pages5
JournalAnesthesiology
Volume77
Issue number6
StatePublished - 1992

Fingerprint

Bupivacaine
Arthroscopy
Morphine
Analgesics
Knee
Analgesia
Epinephrine
Epidural Anesthesia
Opioid Analgesics
Recovery Room
Opioid Receptors
Postoperative Pain
Local Anesthetics
Analysis of Variance
Inflammation

Keywords

  • Analgesics, opioid: morphine
  • Anesthetics, local: bupivacaine
  • Pain: postoperative
  • Receptors: opioid
  • Surgery: arthroscopy

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Comparison of postoperative analgesic effects of intraarticular bupivacaine and morphine following arthroscopic knee surgery. / Raja, Srinivasa Naga; Dickstein, R. E.; Johnson, C. A.

In: Anesthesiology, Vol. 77, No. 6, 1992, p. 1143-1147.

Research output: Contribution to journalArticle

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