Pain Management in Patients Who Undergo Outpatient Arthroscopic Surgery of the Knee*

Reuben, Scott S.; Sklar, Joseph H.

doi:10.2106/00004623-200012000-00010

Cited by 104 publications

(76 citation statements)

References 92 publications

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“…10,18 The value of the multimodal approach is that the lowest effective analgesic dose of each drug can be administered, resulting in fewer or less severe adverse effects, such as nausea, sedation, and respiratory depression. 10,17,18,20,21 Whenever possible, nonopioids should be initiated preoperatively (while also following the preoperative fasting guidelines recommended by the American Society of Anesthesiologists [ASA]), intraoperatively, or as soon as the patient is admitted to the PACU. 22…”

Section: Multimodal Analgesiamentioning

confidence: 99%

“…20,21,27 Reuben and colleagues compared controlled-release (CR) oxycodone (OxyContin; Purdue Pharma LP, Stamford, CT) with IR oxycodone in adult patients post anterior cruciate ligament repair. 20 Patients were randomized to receive 10 mg IR oxycodone every four hours PRN, 10 mg IR oxycodone on a fixed four-hour schedule, or 20 mg of CR oxycodone every 12 hours postoperatively.…”

Section: Oral Opioidsmentioning

confidence: 99%

See 1 more Smart Citation

Orthopaedic Postoperative Pain Management

Pasero¹,

McCaffery²

2007

Journal of PeriAnesthesia Nursing

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Section: Multimodal Analgesiamentioning

confidence: 99%

Section: Oral Opioidsmentioning

confidence: 99%

Orthopaedic Postoperative Pain Management

Pasero¹,

McCaffery²

2007

Journal of PeriAnesthesia Nursing

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“…Pain sometimes affects early discharge even though different regional anesthesia approaches (both central and peripheral as well as intraarticular) have been utilized up to date with conflicting results [12]. It has been shown that intraarticular local anesthetics are effective in analgesia, in addition femoral nerve blocks have also shown a decrease in the post operative opioid analgesia requirements [7,9].…”

Section: Introductionmentioning

confidence: 99%

Saphenous nerve block is an effective regional technique for post-menisectomy pain

Akkaya

Ersan

Özkan

et al. 2008

Knee Surg Sports Traumatol Arthr

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In this study we have evaluated the post menisectomy pain relief offered by Saphenous nerve block. This study was planned on 40 patients with a pre-operative and post operative diagnosis of medial meniscus lesion undergoing partial menisectomy arthroscopically. Patients were randomized into 2 groups where Group I received a preoperative Saphenous block while group 2 did not receive a peripheral block, but received 1 ml of saline as placebo injection. After blocks both groups received general anesthesia and IV patient controlled analgesia (PCA) with tramadol for post operative pain relief. Patients rest and activity pain scores were evaluated on post operative 0, 2, 4, 6, 12 and 24 h using visual analog scale (VAS). Total tramadol consumption as well as pain at rest, when weight bearing and the need for external support while walking were recorded. Group I VAS scores were statistically lower then group II during the time of observation periods at rest as well as active movement periods. Tramadol consumption through IV PCA was statistically significantly lower in group I than in group II (P < 0.05). Pain during walking measured at 24 h was significantly different with better results in group I (P < 0.001). Saphenous nerve block is used for different indications; it can also be a good analgesic method for arthroscopic interventions. We have shown it to be effective after medial partial menisectomies. According to our knowledge this report is the first one utilizing saphenous nerve block for pain after arthroscopic medial menisectomy.

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“…Several reviews which have evaluated the literature data on IA administration of opioids revealed that the quality of most of the studies involving IA administration of morphine were weak. (1,6,(15)(16)(17) Intraarticular use of morhine is contraversial with some positive (1,(16)(17)(18) and some negative results. (19)(20)(21) Thus the authors recommended further randomized controlled trials to clarify the contradictory results published in the literature.…”

Section: Discussionmentioning

confidence: 99%

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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Pain Management in Patients Who Undergo Outpatient Arthroscopic Surgery of the Knee*

Cited by 104 publications

References 92 publications

Orthopaedic Postoperative Pain Management

Orthopaedic Postoperative Pain Management

Saphenous nerve block is an effective regional technique for post-menisectomy pain

Postoperative Effectiveness of Three Routes of Morphine in Arthroscopic Knee Surgery

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