Analgesic Efficacy of the Intra-Articular Administration of High Doses of Morphine in Patients Undergoing Total Knee Arthroplasty

Garcia, João Batista Santos; Neto, José Osvaldo Barbosa; Vasconcelos, José Wanderley; Ferro, Letácio Santos Garcia; Silva, Rafaelle Carvalho e

doi:10.1016/s0034-7094(10)70001-5

Cited by 15 publications

(21 citation statements)

References 30 publications

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“…Previous studies have reported convincing evidence for lower morphine consumption in patients who had received LIA during TKA. 1,2,[21][22][23]27,28,30,31,33 However, none of the previous studies assessed morphine demand. In the present study, the reduction of both morphine demand and consumption in the LIA group further support the conclusion that the use of LIA improved pain control after TKA.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, a reduction of 40% in morphine usage was considered to be a clinically relevant difference. 27 Based on previous studies, the mean (standard deviation) of total morphine usage was 20.6 (6.8) mg. 2,28 Using the above alpha and power values, a sample size of 11 patients per group was needed to detect a 40% reduction in morphine usage.…”

Section: Sample Sizementioning

confidence: 99%

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Local infiltration analgesia in primary total knee arthroplasty

Fang¹,

Lee²,

Chang³

et al. 2019

Hong Kong Med J

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Postoperative pain in total knee arthroplasty (TKA) can hinder rehabilitation and cause morbidity. Local infiltration analgesia (LIA), comprising an anaesthetic drug, non-steroidal anti-inflammatory drug, and adrenaline, has been introduced to reduce pain and systemic side-effects. This study evaluated the efficacy of LIA in TKA with respect to morphine consumption and postoperative pain score. Methods: This single-centre retrospective cohort study recruited patients with knee osteoarthritis who were scheduled for primary TKA during the period from January 2017 to December 2017. Patients with chronic inflammatory joint disease, contra-indications for LIA, or dementia were excluded. Patients in the LIA group were administered single-dose LIA intra-operatively, while those in the control group were not. Primary outcomes were postoperative pain score, morphine demand, and morphine consumption; secondary outcomes were range of motion, quadriceps power, and postoperative length of stay. Results: In total, 136 patients were recruited (68 per group). Total postoperative morphine demand

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Section: Discussionmentioning

confidence: 99%

Section: Sample Sizementioning

confidence: 99%

Local infiltration analgesia in primary total knee arthroplasty

Fang¹,

Lee²,

Chang³

et al. 2019

Hong Kong Med J

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“…16 Third, several trials found the effectiveness of peripheral opioid injections for local analgesia, such as intra-articular morphine after knee surgery. 17,18 Local opioid analgesic actions are pronounced in inflamed tissues. This may be attributed to the increased number of exposed opioid receptors and/or increased coupling with G-proteins (the degradation of perineural barriers and passage of agonists results in exposure of opioid receptors).…”

Section: Enrollmentmentioning

confidence: 99%

<p>Analgesic Effect of Morphine Added to Bupivacaine in Serratus Anterior Plane Block Following Modified Radical Mastectomy. Only a Local Effect? Randomized Clinical Trial</p>

Sherif¹,

El-Rahman²,

Othman³

et al. 2020

JPR

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Background: Serratus anterior plane (SAP) block, a novel regional anesthetic procedure, involves the anterolateral chest wall. Opioid receptors have been found on peripheral nerve terminals, so morphine may have a local action. Objective: This work aimed at exploring the analgesic efficacy of morphine added to bupivacaine in SAPB in patients for whom modified radical mastectomy was conducted and whether it is a mere local effect. Methods: Forty female patients were planned to have modified radical mastectomy participated in the study. Patients were randomly divided into two groups; Control group (C): received ultrasound-guided serratus anterior plane block with 20 mL of bupivacaine hydrochloride 0.25%; Morphine group (M): received the same in addition to 10 mg morphine sulfate. Intra-and postoperative blood samples were taken for the assessment of morphine serum levels. All patients were assessed for VAS scores during rest and movement (VAS-R and VAS-M). Time to the first request and the total amount of the rescue analgesia were recorded. Results: In group M, Morphine was not detected in the plasma of all patients. Both VAS-R and VAS-M were significantly higher in group C than in group M (P<0.001) and (P≤0.003), respectively. Time to the first request of rescue analgesia was 8.5 h in group C compared to 20 h in group M (P=0.005) with a median dose of acetaminophen consumption of 2 g in group C compared to 1 g in group M (P=0.006). Conclusion: Ten mg of morphine, when added to bupivacaine in SAPB, improved postoperative analgesia in patients to whom modified radical mastectomy was conducted. This effect seems to be attributed merely to local mechanisms. Registration: The registration number of this study is NCT02962024 at www.clinicaltrial. gov.

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“…1,2) Epidural analgesia is one of the effective methods for pain management after total knee arthroplasty.However, epidural analgesia can cause dural puncture and lead to complications such as post-dural puncture headache, low back pain, cord injury, epidural hematoma and neurologic symptoms. Although, epidural analgesia has been reported to have very low epidural abscess rates, 3) infection could be a serious and life-threatening problem if there is no early diagnosis and treatment.…”

mentioning

confidence: 99%

“…1,2) Epidural analgesia is one of the effective methods for pain management after total knee arthroplasty.…”

mentioning

confidence: 99%

Epidural Abscess Following Epidural Catheterization for Painless Mobilization after Total Knee Arthroplasty

Lee

Wang

Song

2014

J Korean Orthop Assoc

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To prevent complications from delayed rehabilitation and to promote early recovery of the joint function after total knee arthroplasty, various options of postoperative pain control have been suggested. 1,2) Epidural analgesia is one of the effective methods for pain management after total knee arthroplasty.However, epidural analgesia can cause dural puncture and lead to complications such as post-dural puncture headache, low back pain, cord injury, epidural hematoma and neurologic symptoms. Although, epidural analgesia has been reported to have very low epidural abscess rates, 3) infection could be a serious and life-threatening problem if there is no early diagnosis and treatment. Back pain is an early sign of infection related to epidural analgesia, 4) but may be ignored in postoperative elderly patients who had been having back pain prior to an operation. We report a patient who developed an epidural abscess following lumbar epidural catheterization for painless rehabilitation after total knee arthroplasty. CASE REPORTA 68-year-old woman undertook staged bilateral total knee arthroplasty. Her medical history included chronic hepatitis C and hypertension, which were well managed by medication. The patient immediately started straight leg raising and quadriceps isometric exercise after surgery, and range of motion (ROM) exercise using continuous passive motion (CPM) on the 2nd postoperative day. However, due to pain, she had difficulty in achieving scheduled ROM of operated knees. Therefore, fentanyl transdermal patch (Durogesic D-TRANS; Janssen-Cilag) was added to routine postoperative pain regimen, while intravenous patient controlled analgesia (IV PCA) was still maintained.On the 24th postoperative day, the ROM of the right knee was Epidural analgesia is one of the effective methods for pain management after total knee arthroplasty. Although epidural analgesia has been reported to have very low epidural abscess rates, infection could be serious and life-threatening, if there is no early diagnosis and treatment. We report on a patient who developed an epidural abscess following epidural catheterization after total knee arthroplasty.

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Analgesic Efficacy of the Intra-Articular Administration of High Doses of Morphine in Patients Undergoing Total Knee Arthroplasty

Cited by 15 publications

References 30 publications

Local infiltration analgesia in primary total knee arthroplasty

Local infiltration analgesia in primary total knee arthroplasty

<p>Analgesic Effect of Morphine Added to Bupivacaine in Serratus Anterior Plane Block Following Modified Radical Mastectomy. Only a Local Effect? Randomized Clinical Trial</p>

Epidural Abscess Following Epidural Catheterization for Painless Mobilization after Total Knee Arthroplasty

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