Intra-Articular Morphine Enhances Analgesic Efficacy of Ropivacaine for Knee Arthroscopy in Ambulatory Patients

Abstract

The aim of this double-blind, randomized control trial was to compare the effectiveness of intra-articular ropivacaine alone or with morphine or ketoprofen for controlling pain after arthroscopic knee surgery. One hundred fifty-six patients scheduled for elective knee arthroscopy were recruited. All patients received general anesthesia and were randomly assigned to 4 groups to receive intra-articular ropivacaine 40 mg (group R), ropivacaine 24 mg plus morphine 8 mg (group R+M), ropivacaine 36 mg plus ketoprofen 100 mg (group R+K), or normal saline (group N/S). Pain, sedation, orientation, nausea, vomiting, and urine retention were recorded at 0, 1, 2, 4, 8, 12, and 24 hours postoperatively. Pain was evaluated by a 10-cm visual analog scale (VAS). When the pain was >2, a suppository of 400 mg paracetamol plus 10 mg codeine plus 50 mg caffeine was given. Results showed that at 4 hours postoperatively, pain differed significantly among the 4 groups ( P <.001), with less pain recorded in the R+M group. Similarly, the number of suppositories administered postoperatively to the R+M group was significantly less ( P <.001) vs the other groups. Patients who received ropivacaine and morphine or normal saline had a higher incidence of nausea and vomiting vs the other groups ( P =.001 and P =.036, respectively). The combination of intra-articular ropivacaine and morphine is associated with less pain after knee arthroscopy during early recovery but with a higher incidence of nausea and vomiting. However, the addition of ketoprofen to ropivacaine provides relatively satisfactory pain relief, but with fewer side effects compared to morphine.

Single-dose intra-articular ropivacaine after arthroscopic knee surgery decreases post-operative pain without increasing side effects: a systematic review and meta-analysis

“…Four studies reported participants’ rescue analgesia requirement [7, 25, 36, 42]. No significant difference was identified between the ropivacaine group and the control group (Fig.…”

“…After in‐depth review of 28 papers, 20 were excluded for a variety of reasons, including there being no placebo or blank control group, ropivacaine was co‐administered with other analgesics, or the full text was not available. Ultimately, eight papers [7, 13, 20, 25, 26, 36, 41, 42] were included in the final analysis (Fig. 1).…”

“…2. Two trials were judged to be at low risk of bias [26, 41], two had unclear random sequence generation [7, 13], four had unclear allocation concealment [20, 25, 36, 42], and one was at high risk of unblinding participants, as the control group did not receive an injection [20]. Furthermore, two trials did not describe the supplementary analgesia provided for participants, so they were graded as being at high risk of selective reporting [13, 20].…”

“…Single‐dose IA ropivacaine appears to be safe. In this meta‐analysis, only two studies [25, 36] reported the incidence of drug‐related side effects, and there was no significant difference in the incidence of nausea or vomiting between the ropivacaine and placebo group. This finding establishes the safety of single‐dose IA ropivacaine in humans in the very short‐term observation, but none of the studies observed the participants long enough to have detected chondrotoxicities.…”

“…Since its first clinical use in 1996 [28], ropivacaine has gained popularity as it is reportedly less toxic than other local anaesthetics, such as bupivacaine and lidocaine [15, 30, 35], and consequently, ropivacaine is now also often used for analgesia after arthroscopy. Nevertheless, the analgesic benefit and safety of single‐dose IA ropivacaine for pain management after arthroscopic knee surgery has not been fully established [7, 13, 20, 25, 26, 36, 41, 42]. With newly accumulated evidence, the purpose of this systematic review and meta‐analysis was to appraise the therapeutic benefits of single‐dose IA ropivacaine for pain control after arthroscopic knee surgery, as well as its side effects (including chondrotoxicity).…”