Hege-Scheuing G, Michaelsen K, Bühler A, Kustermann J, Seeling W
Sektion Schmerztherapie, Universitätsklinik für Anästhesiologie Ulm.
Anaesthesist. 1995 May;44(5):351-8. doi: 10.1007/s001010050164.
Previous studies investigating the peripheral action of locally instilled morphine after arthroscopic knee surgery found evidence for an analgesic effect. Follow-up studies have lead to conflicting results. We used patient-controlled analgesia (PCA) to test the analgesic potency of intraarticular morphine. METHODS. Patients undergoing arthroscopic knee surgery under general anaesthesia received, after written informed consent and in double-blind and randomised manner, 1 mg morphine diluted in 10 ml saline either intraarticularly or intravenously at the end of the surgical procedure. A control injection of 10 ml saline was given at the other site. The pain intensity on a visual analogue scale (VAS) and the cumulative morphine consumption were recorded at 1, 2, 3, 4, 6, 8 and 24 h after the end of general anaesthesia.
Wilcoxon rank sum test with P < 0.05. RESULTS. A total of 59 patients were included in the study; 29 received morphine intraarticularly (verum group), 30 intravenously (control group). There was no difference in gender, age, duration of arthroscopy or anaesthesia. There were more than 60% diagnostic arthroscopies in both groups; other types of surgery were comparable, with the exception of cruciate band repair procedures only in the control group. We found no difference in morphine consumption or pain intensity between the two groups throughout the study period. Median overall consumption of morphine after 24 h was 14 mg in the verum group and 15 mg in the control group, with wide interindividual variation. Pain intensities were remarkably low. The peak pain intensity of both groups was found at 1 h postoperatively, with median 16/100 on the VAS in both groups. Blinding was robust. CONCLUSION. We found no reduction in postoperative morphine supplementation after 1 mg morphine intraarticularly compared to 1 mg intravenously given at the end of knee arthroscopies. There were also no differences in pain intensities on a VAS. We conclude that titration of postoperative pain with a morphine-filled PCA pump was unable to show a difference in analgesic potency between intraarticular and intravenous morphine.
先前关于关节镜膝关节手术后局部注射吗啡外周作用的研究发现了镇痛效果的证据。后续研究结果相互矛盾。我们采用患者自控镇痛（PCA）来测试关节内注射吗啡的镇痛效力。方法：接受全身麻醉下关节镜膝关节手术的患者，在签署书面知情同意书后，以双盲随机方式在手术结束时于关节内或静脉内注射用10ml生理盐水稀释的1mg吗啡。在另一部位注射10ml生理盐水作为对照。在全身麻醉结束后1、2、3、4、6、8和24小时记录视觉模拟量表（VAS）上的疼痛强度和吗啡累积用量。
采用Wilcoxon秩和检验，P<0.05。结果：本研究共纳入59例患者；29例接受关节内注射吗啡（试验组），30例接受静脉注射（对照组）。两组在性别、年龄、关节镜检查或麻醉持续时间方面无差异。两组诊断性关节镜检查均超过60%；其他类型手术相当，对照组除外仅有的交叉韧带修复手术。在整个研究期间，我们发现两组之间的吗啡用量或疼痛强度无差异。试验组24小时后吗啡总用量中位数为14mg，对照组为15mg，个体间差异较大。疼痛强度非常低。两组的疼痛强度峰值均出现在术后1小时，两组VAS中位数均为16/100。盲法可靠。结论：与膝关节镜检查结束时静脉注射1mg吗啡相比，关节内注射1mg吗啡后术后吗啡补充量未减少。VAS疼痛强度也无差异。我们得出结论，使用装有吗啡的PCA泵滴定术后疼痛未能显示关节内和静脉内注射吗啡在镇痛效力上的差异。
