Intraarticular morphine for post operative analgesia in knee arthroscopy
Abstract
Arthroscopy has dramatically changed the orthopedic surgeon’s approach to the diagnosis and treatment of varity of joint ailments. A degree of clinical accuracy, combined with low morbidity has encouraged the use of arthroscopy to assist in diagnosis to determine prognosis and often to provide treatment. Recent work has described peripheral ipioid preceptors in skin and synovium. The later may respond to the use of intra-articular morphine for analgesia following knee arthroscopy.Fifty patients who had undergone different arthroscopy procedure for the last one and half years from March 2007 to July 2008 were prospectively evaluated. Of the total arthroscopic producers evaluated meniscal pathology was found in 30 patients. Synovial pathology in3 patients, Anterior Curiae Ligament (ACL) and Posterior Cruciate Ligament (PCL) insufficiency in 5 patients, Chandral lesions in 6 patients, tight lateral structures in 2 patients and losse bodies in 3 patients. All the patient were operated on out basis. Routine intra-articular morphine (2 mg) was used for postoperative pain relief. Drain was not put following the procedures. All the patients were seen on the 15thpostoperative day. Most patients were satisfied with the pain relief modality and needed analgesics in few patient Postoperative low does intra-articular morphine injection has been found to be good alternative to the pain management modalities.References
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2 Mening RP, Holtgrewe JL, Wiedel JD. Plasma bupivacane levels following single does intra- artacular insitllantion after arthrosecopy . Am. J sports Mad 1988;16:295- 299.
3 Wasudev G, smith BE, Umbird TJ, Blood levels of bupivacaine after arthroscopy of the knee joint Arthroscopy 1990;6:40
4 Stein c, Carnisel K Haimerl E, Yassouridis A, Lehr’ Berger K herz, A Peter K. Analgesic effects of intra – artlcular morphine after arthroscopic knee surgery. N Engl J Med 1991;325:1123-1126
5 Stein m C Millan MJ, Shippenberg TS, Herz A, Peripheral effect o ffentanyl upon nofiception of inflamed tissue of the rat , - Neuroscilett 19$B: 225-228 .
6 Chirwa SS Macleod BA Day B. Intra- articular bupivacane ( Marcaine ) after arthroscopic meniscectonmy . A randomized double- blind controlled study . Arthoscopic 1989 ; 5:33-35.
7 Ngo I, Hamilton w. wither w. Andrea R. Local anaesthesia with sedation for arthoscopic surgery of the knee: a report of 100 consecutive cases. Arthroscopy 1985;1:237-241.
8 Khoury GF. Chen CAN, Garland De, Stein, C Intraardcular morphine, bupivacaine ar d morphine/ bupivacine for pain control after knee video arthroscapy. Anesthesiology 1992;77:263-266.
9 Henderson RC, Campion ER, Demasi RA, Taft TN. Postarthroscop-y analgesia with bupivacaine. A prospective. Randomized, blinded evaluation Am J Sports Med 1990; 18:614-617.
10 Joris JL, Dubner R, Hargeaves KM. Opoid analgesia at peripheral sites : A target for opioids released during strees and inflammation. Anesth Analg 1987; 66:12771281.
11 Stein. C Peripheral mechanisms of opioid analgesia aneshth analg 1993;76:152-191.
12 Basbaum At, Levine JD. Opiate Analgeisa : How Central is a peripheral target ? N Engl J Med 1991;325:116 &1169.
13 Prazewlocki R, Hassan AHS, Lason W, Epplen C Herz A, Stein C. Gene expression and localization opioid peptides in immune cells of inflamed tissue : functional role in anti nociception. Neuroscience 1992;48:491-500.
14 Yaksh TL Substance P. release from knee joint afferent terminals : Modulation by opiods. Barin Res 1988; 458:319-324.
15 Taiwo YO, Levine JD. Kappa and delta-opioids block sympathetically dependent hyperlagesia. J Neurosci 1991;11:928-932.
16 Allen GC, St Amand MA, Lui ACP, Johnson DH, Lindsay MP, Post arthroscopy analgesia with intran articular bupivacine/ morphine. A randomized clinical trial. Anesdresio % gy 1993 ; 79475-480.
17 Mc Swiney MM, Joshi GP, Kenny P, Mc Carroll SM. Analgeisa following arthoscopic knee surgery. A controlled. Study of intraarticular morphine. Bupivracaine or both combined. Anaesth Intens Care 1993;21:201-203.
18 Haynes TK, Appadurai JR, Power 1, Rosen M, Grant A. Intraarticular Morphine and bupivacaine. Analgesic afterarthroscopic knee surgery. Anaesthesia 1994;49:5456.
19 Joshi GP, Mc Carroll SM. Cooney CM Blunnie WP. O’ Brien TM, Lawrence Ad. Intra.articular morphine for pain relief after knww arthroscopy. Bone Javant Suffy 1992; 74B 749-751.
20 Lawrence Ad. Josti GP. Michal Hciewicz A, Blunnie I NP, Moriarty DC, Evidence for analgesia mediated by peripheral opiod receptors in inflamed synovial tissue. Eur J C-lin Pharmacol 1992;43:351-355.
2 Mening RP, Holtgrewe JL, Wiedel JD. Plasma bupivacane levels following single does intra- artacular insitllantion after arthrosecopy . Am. J sports Mad 1988;16:295- 299.
3 Wasudev G, smith BE, Umbird TJ, Blood levels of bupivacaine after arthroscopy of the knee joint Arthroscopy 1990;6:40
4 Stein c, Carnisel K Haimerl E, Yassouridis A, Lehr’ Berger K herz, A Peter K. Analgesic effects of intra – artlcular morphine after arthroscopic knee surgery. N Engl J Med 1991;325:1123-1126
5 Stein m C Millan MJ, Shippenberg TS, Herz A, Peripheral effect o ffentanyl upon nofiception of inflamed tissue of the rat , - Neuroscilett 19$B: 225-228 .
6 Chirwa SS Macleod BA Day B. Intra- articular bupivacane ( Marcaine ) after arthroscopic meniscectonmy . A randomized double- blind controlled study . Arthoscopic 1989 ; 5:33-35.
7 Ngo I, Hamilton w. wither w. Andrea R. Local anaesthesia with sedation for arthoscopic surgery of the knee: a report of 100 consecutive cases. Arthroscopy 1985;1:237-241.
8 Khoury GF. Chen CAN, Garland De, Stein, C Intraardcular morphine, bupivacaine ar d morphine/ bupivacine for pain control after knee video arthroscapy. Anesthesiology 1992;77:263-266.
9 Henderson RC, Campion ER, Demasi RA, Taft TN. Postarthroscop-y analgesia with bupivacaine. A prospective. Randomized, blinded evaluation Am J Sports Med 1990; 18:614-617.
10 Joris JL, Dubner R, Hargeaves KM. Opoid analgesia at peripheral sites : A target for opioids released during strees and inflammation. Anesth Analg 1987; 66:12771281.
11 Stein. C Peripheral mechanisms of opioid analgesia aneshth analg 1993;76:152-191.
12 Basbaum At, Levine JD. Opiate Analgeisa : How Central is a peripheral target ? N Engl J Med 1991;325:116 &1169.
13 Prazewlocki R, Hassan AHS, Lason W, Epplen C Herz A, Stein C. Gene expression and localization opioid peptides in immune cells of inflamed tissue : functional role in anti nociception. Neuroscience 1992;48:491-500.
14 Yaksh TL Substance P. release from knee joint afferent terminals : Modulation by opiods. Barin Res 1988; 458:319-324.
15 Taiwo YO, Levine JD. Kappa and delta-opioids block sympathetically dependent hyperlagesia. J Neurosci 1991;11:928-932.
16 Allen GC, St Amand MA, Lui ACP, Johnson DH, Lindsay MP, Post arthroscopy analgesia with intran articular bupivacine/ morphine. A randomized clinical trial. Anesdresio % gy 1993 ; 79475-480.
17 Mc Swiney MM, Joshi GP, Kenny P, Mc Carroll SM. Analgeisa following arthoscopic knee surgery. A controlled. Study of intraarticular morphine. Bupivracaine or both combined. Anaesth Intens Care 1993;21:201-203.
18 Haynes TK, Appadurai JR, Power 1, Rosen M, Grant A. Intraarticular Morphine and bupivacaine. Analgesic afterarthroscopic knee surgery. Anaesthesia 1994;49:5456.
19 Joshi GP, Mc Carroll SM. Cooney CM Blunnie WP. O’ Brien TM, Lawrence Ad. Intra.articular morphine for pain relief after knww arthroscopy. Bone Javant Suffy 1992; 74B 749-751.
20 Lawrence Ad. Josti GP. Michal Hciewicz A, Blunnie I NP, Moriarty DC, Evidence for analgesia mediated by peripheral opiod receptors in inflamed synovial tissue. Eur J C-lin Pharmacol 1992;43:351-355.
Published
2015-03-20
How to Cite
BHATTA, S K; GAUCHAN, S.
Intraarticular morphine for post operative analgesia in knee arthroscopy.
J Soc Surg Nep, [S.l.], v. 14, n. 1, mar. 2015.
ISSN 2392-4772.
Available at: <https://www.jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=34>. Date accessed: 05 oct. 2024.
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Original Article
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