Department of Anaesthesiology and Reanimation, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
Knee Surg Sports Traumatol Arthrosc. 2010 Nov;18(11):1487-95. doi: 10.1007/s00167-010-1061-0. Epub 2010 Feb 4.
Effective pain control is important after an outpatient arthroscopic knee surgery to permit early discharge and improve outcome. The aim of this study was to compare intraarticular morphine and bupivacaine with placebo for postoperative pain control and outpatient status after a knee arthroscopic surgery under a low dose of spinal anaesthesia. After obtaining the ethic committee's approval and written informed consents from 60 adult outpatients undergoing knee arthroscopy, patients were enrolled in this prospective, randomized, double-blinded, placebo-controlled clinical study. All patients received spinal anaesthesia with 1.4 ml of hyperbaric bupivacaine 0.5%. Patients were randomly divided into three groups as morphine (group M, n =20), bupivacaine (group B, n = 20), and placebo (group C, n = 20). After the surgical procedure, patients received one of the following solutions intraarticularly in a double-blinded randomized manner: 5 mg morphine in 20 ml saline, 20 ml 0.25% bupivacaine, or 20 ml saline. Postoperative pain was assessed using a 10-cm visual analogue scale (VAS). Patient characteristics, hemodynamic values, sensory and motor blocks, VAS values, rescue analgesics, discharge time, and patient satisfaction were recorded. There were no significant differences in patient characteristics, surgery and tourniquet time, hemodynamic values, and sensory and motor blocks. The VAS values at 30, 60, and 90 min were similar among the three groups. The VAS values at rest and during move were higher in group C than in groups M and B at 120, 150, 180 min, and 24 h (P < 0.001). There was no difference in VAS values between the groups M and B. Rescue analgesics used and discharge time were significantly different in the placebo group when compared to groups M and B (P < 0.001). Side effects were similar among the groups. Patient satisfaction scores were high in the groups M and B. Administration of 5 mg morphine and 20 ml of 0.25% bupivacaine intraarticularly provides better pain relief and shorter discharge time without increasing the side effects than placebo for an outpatient arthroscopic knee surgery performed under a low dose of spinal anaesthesia.
有效的疼痛控制对门诊关节镜膝关节手术后的早期出院和改善预后很重要。本研究的目的是比较关节内吗啡和布比卡因与安慰剂在低剂量脊髓麻醉下膝关节镜手术后的术后疼痛控制和门诊状态。在获得伦理委员会批准和 60 名接受膝关节镜检查的成年门诊患者的书面知情同意书后，患者被纳入这项前瞻性、随机、双盲、安慰剂对照的临床研究。所有患者均接受 1.4ml 重比重布比卡因 0.5%的脊髓麻醉。患者随机分为三组：吗啡组（M 组，n=20）、布比卡因组（B 组，n=20）和安慰剂组（C 组，n=20）。手术后，患者以双盲随机方式接受以下一种关节内溶液：5mg 吗啡 20ml 生理盐水、20ml0.25%布比卡因或 20ml 生理盐水。术后疼痛采用 10cm 视觉模拟评分（VAS）评估。记录患者特征、血流动力学值、感觉和运动阻滞、VAS 值、解救性镇痛药、出院时间和患者满意度。三组患者的一般情况、手术和止血带时间、血流动力学值、感觉和运动阻滞无显著差异。三组患者术后 30、60 和 90min 时的 VAS 值相似。在 120、150、180min 和 24h 时，C 组静息和运动时的 VAS 值均高于 M 组和 B 组（P<0.001）。M 组和 B 组 VAS 值无差异。与 M 组和 B 组相比，安慰剂组的解救性镇痛药使用和出院时间差异有统计学意义（P<0.001）。各组的副作用相似。M 组和 B 组的患者满意度评分较高。与安慰剂相比，关节内注射 5mg 吗啡和 20ml0.25%布比卡因可提供更好的疼痛缓解和更短的出院时间，且副作用无增加，用于低剂量脊髓麻醉下的门诊关节镜膝关节手术。
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