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AMBULATORY ANESTHESIA

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

Wanda Joshi, DO^*, Scott S. Reuben, MD^*, Prasad R. Kilaru, MD^*, Joseph Sklar, MD, and Holly Maciolek, RN^*

* Departments of Anesthesiology and Orthopedics, Baystate Medical Center and the Tufts University School of Medicine, Springfield, Massachusetts

Address correspondence and reprint requests to Scott S. Reuben, MD, Department of Anesthesiology, Baystate Medical Center, 759 Chestnut St., Springfield, MA 01199. Address e-mail to scott.reuben{at}bhs.org

Both clonidine, an 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 µg/kg; Group BM received 30 mL 0.25% bupivacaine and morphine 3 mg; and Group BCM received 30 mL 0.25% bupivacaine, clonidine 1 µg/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.

Implications: The intraarticular administration of both clonidine and morphine along with bupivacaine improves postoperative analgesia compared with either drug alone. There was an increased time to first analgesic request, decreased need for postoperative analgesics, and lower pain scores after arthroscopic knee surgery.

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