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Low-dose intra-articular morphine analgesia in day case knee arthroscopy: a randomized double-blinded prospective
Joergen Dalsgaard1, Sven Felsby, Palle Juelsgaard
1Departments of Anaesthesia, Aarhus Amtssygehus, Aarhus University Hospital, DK-8000 Aarhus CDenmark Departments of Orthopaedic Surgery, Aarhus Amtssygehus, Aarhus University Hospital, DK-8000 Aarhus CDenmark.
Abstract:
The aim of this study was to demonstrate the effect of intra-articular morphine following knee arthroscopy performed in infiltration analgesia. Fifty-two healthy patients were randomized to receive either 1 mg of morphine or placebo. The pain was assessed 2, 4, 8 and 24 h after the procedure by (1) a VAS scale and (2) the amount of acetaminophen consumed. Demographic data in the 2 groups were similar. The pain scores at 8 and 24 h and the acetaminophen consumption after 8 h were lower in the morphine group (P < 0.05). Our results support the hypothesis of peripherally distributed opioid receptors. Stratifying data in therapeutic versus diagnostic arthroscopy indicated additional effect of morphine in patients undergoing therapy (P < 0.1), an aspect supporting the hypothesis of peripherally administered morphine as a potential suppressor of the substance P-mediated cytokine cascade and the peripheral leukocyte activity. Intra-articular morphine (1 mg) after knee arthroscopy offers efficient analgesia lasting more than 24 h. The method is devoid of side effects and deserves wider recognition.