Arti Hamidreza, Mehdinasab Seyed Abdoulhossein
Associate Professor, Department of Orthopedic Surgery and Trauma Research Center, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
J Res Med Sci. 2011 Sep;16(9):1176-82.
BACKGROUND: Pain after knee surgery, if not relieved, it would lead to a more severe and prolonged pain that can delay the patients recovery and rehabilitation. The effect of pain relief by some drugs after intra-articular injection has been shown. This study compared the effect of intra-articular injection of opioids (morphine, pethidine, methadone, and tramadol) on postoperative relieving pain after arthroscopic anterior cruciate ligament (ACL) reconstruction. METHODS: 150 candidate patients for knee arthroscopic ACL reconstruction were randomly enrolled into five groups. At the end of the procedure, all patients in each group received a joint injection solution including 9.5 millimeters bupivacaine with 1:200,000 epinephrine. The remaining 0.5 milliliters of syringe capacity was filled with one of the five solutions listed below: methadone group I: 5 mg methadone, morphine group II: 5 mg morphine, pethidine group III: 37.5 mg pethidine, tramadol group IV: 100 mg Tramadol, and control group V: 0.5 ml normal saline. Afterwards, any drug further administered to the patients based on need was recorded, and the morphine equivalent for all drugs was calculated. Patients need to narcotic drugs during the first twelve hours of hospitalization and pain scores were recorded. After data gathering, they were analyzed by SPSS 16 software with chi-Square, Kruskal-Wallis and ANOVA statistical tests. RESULTS: The highest and the lowest significant pain intensity were seen in placebo and morphine groups, respectively, in the first, second and third 4 hours after surgery. There were significant differences among the groups for need to analgesics. In other words, placebo group needed the highest dosage of analgesics and morphine and methadone groups needed the lowest dosage of analgesics. Morphine and methadone groups had maximum and minimum response to pain, respectively, in the first, second and third 4 hours after surgery. CONCLUSIONS: Administering 5 mg intra-articular morphine after arthroscopic ACL reconstruction is a valuable choice and is recommended to be added to other local anesthetics administrated drugs after this procedure.
背景：膝关节手术后的疼痛若未得到缓解，会导致更严重且持续时间更长的疼痛，进而延迟患者的恢复和康复进程。已有研究表明关节腔内注射某些药物的止痛效果。本研究比较了关节腔内注射阿片类药物（吗啡、哌替啶、美沙酮和曲马多）对关节镜下前交叉韧带（ACL）重建术后疼痛缓解的效果。 方法：150例拟行膝关节镜下ACL重建的患者被随机分为五组。手术结束时，每组所有患者均接受含9.5毫升布比卡因与1:200,000肾上腺素的关节注射溶液。注射器剩余0.5毫升容量填充以下五种溶液之一：美沙酮组I：5毫克美沙酮，吗啡组II：5毫克吗啡，哌替啶组III：37.5毫克哌替啶，曲马多组IV：100毫克曲马多，对照组V：0.5毫升生理盐水。此后，记录根据需要进一步给予患者的任何药物，并计算所有药物的吗啡等效剂量。记录患者住院前12小时内对麻醉药物的需求及疼痛评分。数据收集后，使用SPSS 16软件通过卡方检验、Kruskal-Wallis检验和方差分析进行分析。 结果：术后第1个、第2个和第3个4小时，安慰剂组和吗啡组分别出现最高和最低显著疼痛强度。各组间在镇痛药需求方面存在显著差异。也就是说，安慰剂组需要的镇痛药剂量最高，吗啡组和美沙酮组需要的镇痛药剂量最低。术后第1个、第2个和第3个4小时，吗啡组和美沙酮组分别对疼痛有最大和最小反应。 结论：关节镜下ACL重建术后关节腔内注射5毫克吗啡是一个有价值的选择，建议在此手术后添加到其他局部麻醉给药药物中。
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