Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Orthop J Sports Med. 2016 Feb 26;4(2):2325967116631335. doi: 10.1177/2325967116631335. eCollection 2016 Feb.
Previous authors have suggested that intra-articular morphine and clonidine injections after knee arthroscopy have demonstrated equivocal analgesic effect in comparison with bupivacaine while circumventing the issue of chondrotoxicity. There have been no studies evaluating the effect of intra-articular morphine after hip arthroscopy.
To evaluate the efficacy of intra-articular morphine in combination with clonidine on postoperative pain and narcotic consumption after hip arthroscopy surgery for femoroacetabular impingement.
Cohort study; Level of evidence, 3.
A retrospective chart review was performed on 43 patients that underwent hip arthroscopy for femoroacetabular impingement at a single institution between September 2014 and May 2015. All patients received preoperative celecoxib and acetaminophen, and 22 patients received an additional intra-articular injection of 10 mg morphine and 100 μg of clonidine at the conclusion of the procedure. Narcotic consumption, duration of anesthesia recovery, and perioperative pain scores were compared between the 2 groups.
Patients who received intra-articular morphine and clonidine used significantly less opioid analgesic (mEq) in the postanesthesia recovery (median difference, 17 mEq [95% CI, -32 to -2 mEq]; P = .02) compared with the control group. There were no differences in time spent in recovery before hospital discharge or in visual analog pain scores recorded immediately postoperatively and at 1 hour after surgery.
Intraoperative intra-articular injection of morphine and clonidine significantly reduced the narcotic requirement during the postsurgical recovery period after hip arthroscopy. The reduction in postsurgical opioids may decrease adverse effects, improve overall pain management, and lead to better quality of recovery and improved patient satisfaction.
先前的作者已经表明，与布比卡因相比，膝关节镜检查后关节内注射吗啡和可乐定在避免软骨毒性的同时，具有相当的镇痛效果。目前还没有研究评估髋关节镜检查后关节内注射吗啡的效果。
评估髋关节镜检查治疗股骨髋臼撞击症术后关节内注射吗啡联合可乐定对术后疼痛和阿片类药物消耗的影响。
队列研究；证据水平，3 级。
对 2014 年 9 月至 2015 年 5 月在一家单机构接受髋关节镜检查治疗股骨髋臼撞击症的 43 例患者进行了回顾性图表审查。所有患者均接受术前塞来昔布和对乙酰氨基酚治疗，22 例患者在手术结束时接受额外的关节内注射 10mg 吗啡和 100μg 可乐定。比较了两组患者的阿片类药物消耗、麻醉恢复时间和围手术期疼痛评分。
接受关节内注射吗啡和可乐定的患者在麻醉恢复后（中位数差值，17mEq [95% CI，-32 至-2mEq]；P =.02）使用的阿片类药物镇痛剂明显减少。两组患者在出院前恢复时间或术后即刻和术后 1 小时记录的视觉模拟疼痛评分方面无差异。
髋关节镜检查术中关节内注射吗啡和可乐定可显著减少髋关节镜检查后康复期间的阿片类药物需求。减少术后阿片类药物的使用可能会降低不良反应、改善整体疼痛管理，并导致更好的康复质量和提高患者满意度。
