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Effective pain relief from intra‐articular saline with or without morphine 2 mg in patients with moderate‐to‐severe pain after knee arthroscopy: a randomized, double‐blind controlled clinical study
Author(s) -
Rosseland L. A.,
Stubhaug A.,
Grevbo F.,
Reikerås O.,
Breivik H.
Publication year - 2003
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1034/j.1399-6576.2003.00155.x
Subject(s) - medicine , morphine , anesthesia , analgesic , adverse effect , saline , randomized controlled trial , visual analogue scale , clinical trial , osteoarthritis , knee pain , surgery , alternative medicine , pathology
Background: Intra‐articular (IA) morphine has given good and prolonged pain relief in some studies when given at the end of arthroscopic procedures in the knee joint. However, similar studies have not been able to document any local analgesic effect of morphine. A large number of the negative studies have not demonstrated any assay sensitivity. We have documented that around 40% of patients have only very mild or no pain after arthroscopic procedures in the knee joint. This obviously is a confounding factor, reducing assay sensitivity when all patients are included in IA morphine studies. Method: By leaving a soft catheter IA in 57 patients and including only patients who developed moderate‐to‐severe pain within 1 h after an arthroscopic procedure in the knee joint under general anaesthesia, we included 40 patients. These patients had a mean pre‐treatment baseline pain of about 50/100 on a 100‐mm visual analogue scale (VAS) for pain intensity. A randomized, double‐blind controlled comparison of saline 10 ml with or without morphine 2 mg followed. Test drugs were administered through the IA catheter. Pain intensity and pain relief, consumption of rescue analgesics and global evaluation of effect and adverse effects were measured up to 36 h thereafter. Results: Pain intensity decreased from about 50 to about 10–15/100 in both groups and the sum of pain intensity differences at 2 and 22 h was not significantly different between the two groups. Global evaluation of effects and adverse effects, as well as consumption of rescue analgesics during 36 h after arthroscopic procedures, were also similar in the two groups. Conclusions: Only 70% of 57 patients had pain of moderate‐to‐severe intensity within 1 h after an arthroscopic procedure of the knee joint under general anaesthesia. IA injection of saline 10 ml and saline 10 ml with morphine 2 mg were both associated with pain relief. These findings may have implications for interpretations of a majority of published studies on IA morphine.