Department of Orthopaedic Surgery, Shiraniwa Hospital Joint Arthroplasty Center, Nara, Japan.
Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
J Arthroplasty. 2017 Dec;32(12):3637-3642. doi: 10.1016/j.arth.2017.07.020. Epub 2017 Jul 21.
The periarticular multimodal cocktail injection including morphine is currently commonly used to reduce postoperative pain following total knee arthroplasty (TKA). Despite its analgesic effect, it frequently causes nausea, which is an adverse effect of opioids. It is inconclusive whether the intraoperative injection of periarticular morphine is effective peripherally. The aim of this study was to assess whether the addition of morphine to unilateral periarticular knee injections improves postoperative pain, range of motion, and swelling in patients undergoing simultaneous bilateral TKA.
A prospective, single-center, double-blinded, randomized, controlled trial was conducted to assess the local efficacy of adding morphine to intraoperative periarticular anesthesia in patients undergoing simultaneous bilateral TKA. Fifty-three patients undergoing 106 TKAs received an intraoperative periarticular injection in randomly selected one knee with added morphine (0.1 mg/kg) and the other knee without added morphine. The periarticular injection was composed of ropivacaine (a local anesthetic), epinephrine, ketoprofen, and methylprednisolone sodium. Visual analog scale pain scores at rest and on motion, range of motion (ROM), thigh swelling, the Western Ontario and McMaster Universities Osteoarthritis Index score, and adverse outcomes were compared between the 2 knees.
There were no statistically significant differences in the visual analog scale score, ROM, thigh girth, Western Ontario and McMaster Universities Osteoarthritis Index score, and adverse events between the 2 sides.
Adding morphine to periarticular injections is ineffective locally for relieving pain, reducing swelling, and improving the postoperative ROM.
关节周围多模式鸡尾酒注射包括吗啡，目前常用于减少全膝关节置换术（TKA）后的术后疼痛。尽管它有镇痛作用，但经常引起恶心，这是阿片类药物的不良反应。关节周围注射吗啡是否在局部有效还没有定论。本研究的目的是评估在同时进行双侧 TKA 时，在关节周围膝关节注射中加入吗啡是否能改善术后疼痛、活动范围和肿胀。
进行了一项前瞻性、单中心、双盲、随机、对照试验，以评估在同时进行双侧 TKA 的患者中，将吗啡加入术中关节周围麻醉的局部疗效。53 例接受 106 例 TKA 的患者随机选择一侧膝关节接受术中关节周围注射，加入吗啡（0.1mg/kg），另一侧膝关节不加入吗啡。关节周围注射由罗哌卡因（局部麻醉剂）、肾上腺素、酮咯酸和甲泼尼龙钠组成。比较 2 侧膝关节的静息和运动时的视觉模拟评分疼痛、活动范围（ROM）、大腿肿胀、西安大略和麦克马斯特大学骨关节炎指数评分和不良结果。
2 侧膝关节的视觉模拟评分、ROM、大腿围、西安大略和麦克马斯特大学骨关节炎指数评分和不良事件均无统计学差异。
在关节周围注射中加入吗啡对缓解疼痛、减轻肿胀和改善术后 ROM 没有局部作用。
