To determine the duration of pain relief and efficacy of intraarticular morphine compared with bupivacaine after outpatient knee arthroscopy under local anesthesia, we gave patients one of three postoperative intraarticular injections: 4 mg morphine, 0.25% bupivacaine, or 0.9% saline. Visual analog scale scores and supplemental pain medication use were recorded at 0 to 30 minutes, 2, 4, 6, 8 to 12, and 24 hours after surgery. The score on the visual analog scale at 24 hours was significantly lower in the morphine group than in the bupivacaine or control groups. The cumulative amount of pain medication used was significantly lower in the morphine and bupivacaine groups at 2 to 6 hours after surgery than in the saline control group. The morphine group used the least supplemental pain medication during the 12 to 24 hour interval (P = 0.06). We found that the use of intraarticular morphine or bupivacaine after outpatient knee arthroscopy will decrease the amount of narcotic medication needed for pain relief during the early postoperative period. In addition, morphine provided prolonged pain relief up to 24 hours when compared with bupivacaine or placebo, and the patients in the morphine group tended to take less supplemental pain medication during the first postoperative day.

We retrospectively reviewed the records of 2050 arthroscopic knee surgeries performed at The Orthopedic Specialty Hospital from January 1993 to December 1994. The number of clinically detected deep venous thromboses, with confirmation by duplex ultrasonography, was determined. Prospectively, preoperative and postoperative duplex ultrasonographic images were completed on 239 patients divided into 2 groups: those undergoing nonligament, intraarticular arthroscopic surgery (N = 131) and those undergoing arthroscopically assisted ligament surgery and extraarticular or osteotomy surgery (N = 108). For the retrospective study, the incidence of deep venous thrombosis was 0.24%. Prospectively, seven total deep venous thromboses were identified (rate, 2.9%), with five being identified within 8 days of surgery in asymptomatic patients (rate, 2.1%). There were no statistically significant associations or correlations between the development of deep venous thrombosis and patient personal data or surgical variables, respectively. The difference in the rate of deep venous thrombosis between the two prospective groups was not statistically significant; however, patients who had more invasive surgery tended to be at higher risk for developing deep venous thrombosis. A cost-benefit analysis did not support the routine use of duplex ultrasonography to detect deep venous thrombosis in patients undergoing arthroscopic knee surgery.

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