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Comparisons of analgesic effects of different doses of morphine and morphine plus methylprednisolone after knee surgery

Published online by Cambridge University Press:  28 July 2005

M. Kizilkaya ,
O. S. Yildirim ,
N. Ezirmik ,
H. Kursad  and
O. Karsan
M. Kizilkaya
Affiliation:
Atatürk University, The School of Medicine, Departments of Anesthesiology and Reanimation, Erzurum, Turkey
O. S. Yildirim
Affiliation:
Atatürk University, The School of Medicine, Department of Orthopaedic Surgery, Erzurum, Turkey
N. Ezirmik
Affiliation:
Atatürk University, The School of Medicine, Department of Orthopaedic Surgery, Erzurum, Turkey
H. Kursad
Affiliation:
Atatürk University, The School of Medicine, Departments of Anesthesiology and Reanimation, Erzurum, Turkey
O. Karsan
Affiliation:
Atatürk University, The School of Medicine, Department of Orthopaedic Surgery, Erzurum, Turkey
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Extract

Summary

Background: In this double-blind randomized study, the analgesic effects of morphine alone and with methylprednisolone were examined in 72 patients undergoing arthroscopic knee surgery. Methods: At the end of arthroscopy, patients were allocated randomly to one of four groups to receive intra-articular administrations of saline, morphine 1 mg, morphine 5 mg or morphine 1 mg with methylprednisolone 40 mg. Preoperative and postoperative pain levels at rest and during movement (active flexion of the knee) were measured by a visual analogue scale (VAS). Postoperative analgesic requirements to alleviate pain were evaluated. Results: Pain scores were significantly lower for the patients who received 5 mg morphine and 1 mg morphine with 40 mg methylprednisolone than for those who received saline or 1 mg morphine. This was accompanied by a decrease in the postoperative consumption of analgesics and prolongation of the duration of pain relief. Conclusions: This study confirms that the analgesic effect of morphine given intra-articularly is dose dependent and that combination of methylprednisolone with morphine has an additive effect on analgesia.

Keywords

MORPHINEMETHYLPREDNISOLONEORTHOPAEDIC SURGERY, kneeINJECTIONS, INTRA-ARTICULARPOSTOPERATIVE PERIODPAIN, POSTOPERATIVE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 8 , August 2005 , pp. 603 - 608
Copyright
© 2005 European Society of Anaesthesiology

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References

Alvarez-Cabo JM, López-Rouco M, González-Paleo JR. Analgesic effect of intra-articular morphine after arthroscopic knee surgery. Ambul Surg 1998; 6: 179–182.Google Scholar
Hassan AHS, Ableitner A, Stein C, Herz A. Inflammation of the rat paw enhances axonal transport of opioid receptors in the sciatic nerve and increases their density in the inflamed tissue. Neuroscience 1993; 55: 185–195.Google Scholar
Stein C, Pflüger M, Yassouridis A et al. No tolerance to peripheral morphine analgesia in presence of opioid expression in inflamed synovia. J Clin Invest 1996; 98: 793–799.Google Scholar
Heard SO, Edwards WT, Ferrari D et al. Analgesic effect of intraarticular bupivacaine or morphine after arthroscopic knee surgery. Anesth Analg 1992; 74: 822–826.Google Scholar
Hege-Scheuing G, Michealsen K, Buhler A et al. Analgesie durch intraartikulares morphin nach kneigelenksar throscopien? Anaesthesist 1995; 44: 351–358.Google Scholar
Kizilkaya M, Yildirim OS, Dogan N, Kursad H, Okur A. Analgesic effects of intraarticular sufentanil and sufentanil plus methylprednisolone after arthroscopic knee surgery. Anesth Analg 2004; 98: 1062–1065.Google Scholar
Allen GC, St Amand MA, Lui AC, Johnson DH, Lindsay MP. Postarthroscopy analgesia with intraarticular bupivacaine/morphine. Anesthesiology 1993; 79: 475–480.Google Scholar
Rasmussen S, Lorentzen JS, Larsen AS, Thomsen ST, Kehlet H. Combined intra-articular glucocorticoid, bupivacaine and morphine reduces pain and convalescence after diagnostic knee arthroscopy. Acta Orthop Scand 2002; 73: 175–178.Google Scholar
Kelly PJ, Carboni M, Sforsini CM, Donaldson M. Quality of postoperative analgesia in day-case operative knee arthroscopy: role of fentanyl added to intra-articular bupivacaine and antiinflammatory therapy. Ambul Surg 1999; 7: 123–126.Google Scholar
Brandsson S, Karlsson J, Morberg P, Rydgren B, Eriksson BI, Hedner T. Intraarticular morphine after arthroscopic ACL reconstruction. Acta Orthop Scand 2000; 71: 280–285.Google Scholar
Dennis AR, Leeson-Payne CG, Hobbs GJ. A comparison of diclofenac with ketorolac for pain relief after knee arthroscopy. Anaesthesia 1995; 50: 904–906.Google Scholar
Yang LC, Chen LM, Wang CJ, Buerkle H. Postoperative analgesia by intra-articular neostigmine in patients undergoing knee arthroscopy. Anesthesiology 1998; 88: 334–339.Google Scholar
Kalso E, Tramer MR, Carroll D, Mcquay HJ, Moore RA. Pain relief from intra-articular morphine after knee surgery. Pain 1997; 71: 127–134.Google Scholar
Varkel V, Volpin G, Ben-David B et al. Intraarticular fentanyl compared with morphine for pain relief following arthroscopic knee surgery. Can J Anaesth 1999; 46: 867–871.Google Scholar
Lyons B, Lohan D, Flynn CG et al. Intra-articular analgesia for arthroscopic meniscectomy. Br J Anaesth 1995; 75: 552–555.Google Scholar
Gupta A, Bodin L, Holmstrom B, Berggren L. A systematic review of the peripheral analgesic effects of intraarticular morphine. Anesth Analg 2001; 93: 761–770.Google Scholar
Rosseland LA, Stubhaug A, Grevbo F, Reikeras O, Breivik H. Effective pain relief from intra-articular saline with or without morphine 2 mg in patients with moderate-to-severe pain after knee arthroscopy. Acta Anaesthesiol Scand 2003; 47: 732–738.Google Scholar
Haynes TK, Appadurai IR, Power I, Rosen M, Grant A. Intra-articular morphine and bupivacaine analgesia after arthroscopic knee surgery. Anaesthesia 1994; 49: 54–56.Google Scholar
Marchal JM, Delgado-Martinez AD, Poncela M, Valenzuela J, de Dios Luna J. Does the type of arthroscopic surgery modify the analgesic effect of intraarticular morphine and bupivacaine? A preliminary study. Clin J Pain 2003; 19: 240–246.Google Scholar
Likar R, Kapral S, Steinkellner H, Stein C, Schafer M. Dose-dependency of intra-articular morphine analgesia. Br J Anaesthesia 1999; 83: 241–244.Google Scholar
Kalso E, Smith L, McQuay HJ, Andrew Moore R. No pain, no gain: clinical excellence and scientific rigour – lessons learned from IA morphine. Pain 2002; 98: 269–275.Google Scholar
Stein C, Comisel K, Haimerl E et al. Analgesic effect of intraarticular morphine after arthroscopic knee surgery. N Engl J Med 1991; 325: 1123–1126.Google Scholar
Drosos GI, Vlachonikolis IG, Papoutsidakis AN, Gavalas NS, Anthopoulos G. Intra-articular morphine and postoperative analgesia after knee arthroscopy. Knee 2002; 9: 335–340.Google Scholar
Khoury GF, Chen ACN, Garland DE, Stein C. Intraarticular morphine, bupivacaine, and morphine/bupivacaine for pain control after knee videoarthroscopy. Anesthesiology 1992; 77: 263–266.Google Scholar
Whitford A, Healy M, Joshi GP et al. The effect of tourniquet release time on the analgesic efficacy of intraarticular morphine after arthroscopic knee surgery. Anesth Analg 1997; 84: 791–793.Google Scholar
Montgomery SC, Campbell J. Septic arthritis following arthroscopy and intra-articular steroids. J Bone Joint Surg Br 1989; 71: 540.Google Scholar