Raja S N, Dickstein R E, Johnson C A
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21287-5354.
Anesthesiology. 1992 Dec;77(6):1143-7. doi: 10.1097/00000542-199212000-00015.
Recent studies have shown that, in the presence of inflammation, the local administration of opioids results in analgesia. The analgesic efficacy of local anesthetics and morphine administered intraarticularly was compared in patients undergoing arthroscopic knee surgery under epidural anesthesia. We compared postoperative pain scores (VAS) and opioid requirements among 47 patients receiving, in a randomized, double-blinded fashion, one of three intraarticular medications (20 ml): normal saline with 100 micrograms epinephrine (group 1, n = 16); 0.25% bupivacaine with 100 micrograms epinephrine (group 2, n = 15); and 3 mg morphine sulfate and 100 micrograms epinephrine in normal saline (group 3, n = 16). VAS scores were similar in the groups preoperatively and on arrival in the recovery room. At the end of the first postoperative hour, the residual sensory blockade was minimal in all three groups (mean = 3.8-4.1 segments) and almost total recovery occurred in all three groups before the second postoperative hour. The VAS in group 3 was not significantly different than group 1 at any time interval. Intraarticular bupivacaine (group 2) provided significantly better analgesia than did saline or morphine (group 1 or 3) in the first 2 postoperative hours (ANOVA, P < .05). Subsequent VAS scores were not significantly different in the three groups. While no patient in group 2 requested analgesics during the first postoperative hour, nine patients in group 3 required systemic analgesics (P < .01). We conclude that no evidence for a peripheral opiate-receptor mediated analgesia could be demonstrated in patients undergoing arthroscopic knee surgery under epidural anesthesia.
近期研究表明，在存在炎症的情况下，局部应用阿片类药物可产生镇痛效果。在接受硬膜外麻醉的膝关节镜手术患者中，比较了关节腔内注射局部麻醉药和吗啡的镇痛效果。我们将47例患者随机、双盲分为三组，每组接受一种关节腔内注射药物（20毫升）：含100微克肾上腺素的生理盐水（第1组，n = 16）；含100微克肾上腺素的0.25%布比卡因（第2组，n = 15）；以及含3毫克硫酸吗啡和100微克肾上腺素的生理盐水（第3组，n = 16），比较术后疼痛评分（视觉模拟评分法，VAS）和阿片类药物需求量。三组患者术前及到达恢复室时的VAS评分相似。术后第一小时末，三组的残余感觉阻滞均最小（平均 = 3.8 - 4.1节段），且在术后第二小时前，三组几乎均完全恢复。在任何时间间隔，第3组的VAS与第1组无显著差异。关节腔内注射布比卡因（第2组）在术后前2小时提供的镇痛效果明显优于生理盐水或吗啡（第1组或第3组）（方差分析，P < .05）。随后三组的VAS评分无显著差异。第2组在术后第一小时无患者需要镇痛药物，而第3组有9例患者需要全身镇痛药物（P < .01）。我们得出结论，在接受硬膜外麻醉的膝关节镜手术患者中，未发现外周阿片受体介导的镇痛证据。
