Rosseland L A, Stubhaug A, Grevbo F, Reikerås O, Breivik H
Department of Anaesthesiology, Rikshospitalet University Hospital, Oslo, Norway.
Acta Anaesthesiol Scand. 2003 Jul;47(6):732-8. doi: 10.1034/j.1399-6576.2003.00155.x.
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.
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.
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.
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.
在一些研究中，膝关节镜手术结束时关节内注射吗啡可带来良好且持久的疼痛缓解效果。然而，类似研究未能证实吗啡有任何局部镇痛作用。大量阴性研究未显示出任何检测敏感性。我们已记录到约40%的患者在膝关节镜手术后仅有非常轻微的疼痛或无疼痛。显然，这是一个混杂因素，在将所有患者纳入关节内吗啡研究时会降低检测敏感性。
在57例患者中留置一根软质关节内导管，仅纳入在全身麻醉下膝关节镜手术后1小时内出现中度至重度疼痛的患者，最终纳入40例患者。这些患者在100毫米视觉模拟疼痛量表（VAS）上的治疗前基线平均疼痛强度约为50/100。随后进行了一项随机、双盲对照比较，分别注射含或不含2毫克吗啡的10毫升生理盐水。试验药物通过关节内导管给药。此后36小时内测量疼痛强度和疼痛缓解情况、急救镇痛药的消耗量以及对效果和不良反应的总体评估。
两组患者的疼痛强度均从约50降至约10 - 15/100，两组在2小时和22小时时疼痛强度差异之和无显著差异。两组在关节镜手术后36小时内对效果和不良反应的总体评估以及急救镇痛药的消耗量也相似。
在全身麻醉下膝关节镜手术后1小时内，57例患者中只有70%出现中度至重度疼痛。关节内注射10毫升生理盐水和含2毫克吗啡的10毫升生理盐水均与疼痛缓解相关。这些发现可能对大多数已发表的关于关节内吗啡的研究的解读有影响。
