Analgesic effect of intra‐articular morphine after arthroscopic meniscectomy

Dierking, G.; Øtergaard, H. T.; Dissing, C. K.; Kristensen, JD; Dalhl, J. B.

doi:10.1111/j.1365-2044.1994.tb14236.x

Cited by 43 publications

(8 citation statements)

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“…1 Such imbalance may be of importance in several RCTs. 35,36,38,39,44,45,[48][49][50][51][52][53][54][55][56][57][58][59][60][61] All these trials, placebo controlled or not, had a group size below 20, which gives an OPVS item number 2 score of 0/3.…”

Section: Most Positive Trials Are Of Low Research Quality And/or Havementioning

confidence: 99%

“…93 Unfortunately, several studies did not include placebo groups. 40,49,51,54,81,[94][95][96][97][98] Trials without placebo control (Table 4) are often referred to as evidence for peripheral opioid analgesia. However, there is a lack of evidence from placebo-controlled trials, and the results need to be reviewed in the light of recent knowledge.…”

Section: Most Positive Trials Are Of Low Research Quality And/or Havementioning

confidence: 99%

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No evidence for analgesic effect of intra-articular morphine after knee arthroscopy: A qualitative systematic review

Rosseland

2005

Regional Anesthesia and Pain Medicine

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There are few well-controlled RCTs on IA morphine, and the negative trials of higher quality counter the evidence from the numerous positive ones of lower quality. The quality of most published trials is poor, and performing meta-analysis on these data is not meaningful. Properly controlled trials, in which early postoperative pain intensity is documented, suggest that there is no added analgesic effect of IA morphine compared with saline alone.

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Section: Most Positive Trials Are Of Low Research Quality And/or Havementioning

confidence: 99%

Section: Most Positive Trials Are Of Low Research Quality And/or Havementioning

confidence: 99%

No evidence for analgesic effect of intra-articular morphine after knee arthroscopy: A qualitative systematic review

Rosseland

2005

Regional Anesthesia and Pain Medicine

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“…(28) Presence of local anaesthetics may be a factor to inhibit neuronal mechanisms that are responsible for the effect of morphine. This may explain why some studies with regional or local anaesthesia have failed to show the effect of IA morphine, (29)(30)(31) whereas patients operated under general anaesthesia have demonstrated profound effect of IA morphine. (4,15,32,33) In the current study, spinal anasthesia with bupivacaine was applied.…”

Section: Discussionmentioning

confidence: 96%

Postoperative Effectiveness of Three Routes of Morphine in Arthroscopic Knee Surgery

Atım¹,

Sızlan²,

Ergin³

et al. 2011

J Turk Anaesth Int Care

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SUMMARY Aim:The aim of this study was to investigate postoperative analgesic effectiveness of intraarticular (IA), intramuscular (IM) or intrathecal (IT) administration of morphine in arthroscopic knee surgery.Materials and Methods: Seventy-six patients with ASA physical status I-II, aged 18 to 65 years, undergoing arthroscopic knee surgery were included in the study. Morphine (10 mg) was given via IA and IM in groups IA (n:21) and IM (n:16), respectively, at the end of the surgical procedure. IT 0.1 mg morphine was administered together with the local anesthetic in Group IT (n:21). Morphine was not applied to 18 control patients (Group C). Visual analogue scale scores for pain were analyzed. Additional analgesic requirement, side effects of morphine and hemodynamic parameters were compared between the groups.Results: None of the patients in Group IT needed additional analgesic treatment in the first 24 hours, whereas 14.3 %, 25.0 % and 72.2 % of the patients needed additional analgesic administration in the groups IA, IM and C, respectively (p<0.001). There was no difference in nausea or vomiting between groups (p=0.07). Fifteen patients in Group IT and 3 patients in Group IA experienced itching.Conclusion: Morphine in three administration routes provides similar analgesic effect and better analgesia in comparison to the control group. Due to the higher incidence of side effects in the IT group, either IA or IM route may be chosen for an adequate postoperative analgesia at the dose used in the present study. Gereç ve Yöntem: Artroskopik diz cerrahisi uygulanacak 18-65 yaş arası 76 ASA I-II hasta çalışmaya alındı. İA (n:21) ve İM (n:16) grubunda cerrahi işlemin sonunda morfin 10 mg İA ve 10 mg İM yolla, İT (n:21) grubunda ise 0.1 mg morfin lokal anestezikle birlikte İT yolla verildi. Kontrol grubuna (Grup C,n:18) morfin verilmedi. Ağrı görsel analog skalası ile değerlendirildi. Gruplar ek analjezik gereksinimi, morfinin yan etkileri ve hemodinamik parametreler açısın-dan karşılaştırıldı.Bulgular: İlk 24 saatte IT gruptaki hiçbir hastada ek analjezik gereksinimi olmadı. Buna karşılık İA, İM ve C grubunda sırasıyla % 14.3, % 25.0 ve % 72.2 oranlarında ek lornoksikam gereksinimi oldu (p<0.001). Gruplar arasında bulantı ve kusma açısından anlamlı fark bulunamadı (p=0.07). IT grubundan 15 hastada, IA grubundan da 3 hastada kaşıntı gözlendi.Sonuç: Kontrol grubuyla karşılaştırıldığında İA, İM ve İT uygulanan morfinin daha iyi analjezik etki sağladığı gözlendi. Morfinin kullanılan dozlarında İT grubunda daha yüksek yan etki insidansı oluşturması nedeniyle, benzer şekilde yeterli postoperatif analjezi sağlayan İA ya da İM uygulama yolu tercih edilebilir.

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“…The possibility that pain reduction and the decreased need of analgesics after IA morphine was secondary to a systemic effect was investigated by several authors who demonstrated that the IA was superior than the intravenous route in pain reduction and, in some cases, the intragroup difference did not achieve statistical significance. However, the superiority of the intravenous over the IA route was not demonstrated when similar doses were used 10,27,28 . It was also suggested that the effects of IA morphine were more prolonged that that of the intravenous administration.…”

Section: Discussionmentioning

confidence: 99%

Eficácia analgésica do uso de dose alta de morfina intra-articular em pacientes submetidos à artroplastia total de joelho

Garcia

Neto

Vasconcelos

et al. 2010

Rev. Bras. Anestesiol.

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Analgesic effect of intra‐articular morphine after arthroscopic meniscectomy

Cited by 43 publications

References 10 publications

No evidence for analgesic effect of intra-articular morphine after knee arthroscopy: A qualitative systematic review

No evidence for analgesic effect of intra-articular morphine after knee arthroscopy: A qualitative systematic review

Postoperative Effectiveness of Three Routes of Morphine in Arthroscopic Knee Surgery

Eficácia analgésica do uso de dose alta de morfina intra-articular em pacientes submetidos à artroplastia total de joelho

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