| JOURNAL HOME | CME HOME | THIS MONTH | PAST ISSUES | ETOC | COLLECTIONS |
| AUTHORS | REVIEWERS | EDITORIAL BOARD | FEEDBACK | RSS | HELP |
| ||||||||||||||
| ||||||||||||||
|
|
|
|
||||||||||||
|
||||||||||||||
*Acute Pain Service, Department of Anesthesiology, Baystate Medical Center, and the Tufts University School of Medicine; New England Orthopedic Surgeons, PC, and Baystate Medical Center; and Department of Anesthesiology, Baystate Medical Center, Springfield, MA
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
Intraarticular (IA) morphine provides effective postoperative analgesia after arthroscopic knee surgery. Some investigators have suggested that the preemptive administration of opioids may reduce postoperative analgesic requirements and hypersensitivity. We evaluated the analgesic effect of administering IA morphine either before or after surgical incision in patients undergoing arthroscopic knee surgery under local anesthesia. Forty patients undergoing arthroscopic meniscectomy were randomized into two groups. All patients received IA bupivacaine 0.25% before and after surgery together with IV sedation using midazolam and propofol. The Preemptive IA Morphine group received a single 3-mg dose of morphine with their preoperative bupivacaine. The Post-IA Morphine group received 3 mg of morphine at the completion of surgery with the postoperative bupivacaine. After surgery, pain scores, the time to first opioid use, and 24-h analgesic use were recorded. Analgesic duration, defined as the time from completion of surgery until first opioid use, was significantly longer in those patients receiving preoperative (953 ± 209 min) versus postoperative (556 ± 121 min) IA morphine. The 24-h acetaminophen and oxycodone use was less in the Preemptive group (2.2 ± 1.2 pills) versus the Postoperative group (3.0 ± 1.2 pills). We conclude that IA morphine provides a longer duration of postoperative analgesia with less 24-h opioid use when administered before surgery.
Implications: The administration of intraarticular morphine 3 mg before arthroscopic knee surgery provides a longer duration of analgesia with less 24-h opioid use compared with the administration of the drug at the completion of surgery.
This article has been cited by other articles:
|
|
 |
|
  H. N. Herkowitz, D. R. Dirschl, and D. H. Sohn Pain Management: The Orthopaedic Surgeon's Perspective J. Bone Joint Surg. Am., November 1, 2007; 89(11): 2532 - 2535. [Full Text] [PDF]
|
|
|
|
|
|
S. S. Reuben and A. Buvanendran Preventing the Development of Chronic Pain After Orthopaedic Surgery with Preventive Multimodal Analgesic Techniques J. Bone Joint Surg. Am., June 1, 2007; 89(6): 1343 - 1358. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. M. Tran, T. J. Ganley, L. Wells, A. Ganesh, K. I. Minger, and G. Cucchiaro Intraarticular Bupivacaine-Clonidine-Morphine Versus Femoral-Sciatic Nerve Block in Pediatric Patients Undergoing Anterior Cruciate Ligament Reconstruction Anesth. Analg., November 1, 2005; 101(5): 1304 - 1310. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. F. White The Changing Role of Non-Opioid Analgesic Techniques in the Management of Postoperative Pain Anesth. Analg., November 1, 2005; 101(5S_Suppl): S5 - 22. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. K.-S. Ong, P. Lirk, R. A. Seymour, and B. J. Jenkins The Efficacy of Preemptive Analgesia for Acute Postoperative Pain Management: A Meta-Analysis Anesth. Analg., March 1, 2005; 100(3): 757 - 773. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. B. Dahl and S. Moiniche Pre-emptive analgesia Br. Med. Bull., December 13, 2004; 71(1): 13 - 27. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. F. White The Role of Non-Opioid Analgesic Techniques in the Management of Pain After Ambulatory Surgery Anesth. Analg., March 1, 2002; 94(3): 577 - 585. [Abstract] [Full Text] [PDF]
|
|
|
