Niemi L, Pitkänen M, Tuominen M, Björkenheim J M, Rosenberg P H
Department of Anaesthesia, Helsinki University Central Hospital, Finland.
Acta Anaesthesiol Scand. 1994 May;38(4):402-5. doi: 10.1111/j.1399-6576.1994.tb03916.x.
Eighty patients scheduled to undergo knee arthroscopy were studied in random and double blind fashion. Spinal anaesthesia with hyperbaric 0.5% bupivacaine was selected for 40 overnight-in-patients. At the end of arthroscopy, 1 mg morphine or saline was injected intraarticularly. Local anaesthesia with 1% lidocaine plus adrenaline, was selected for another 40 out-patients. At the end of the arthroscopy either 1 mg morphine or saline was injected intraarticularly. As a rescue medication the spinal anaesthesia patients received oxycodone 0.14 mg kg-1 i.m. or ketoprofen 100 mg p.o. and the local anaesthesia patients received ketoprofen 100 mg p.o. The need for additional postoperative analgesic was almost similar in both spinal anaesthesia groups. The patients having local anaesthesia and given intraarticular morphine needed fewer doses of ketoprofen (22 doses) postoperatively than the control group (39 doses) (P < 0.05). Duration of analgesia was slightly longer after morphine than in the control group (ns). There was no difference between the morphine patients and the control patients in the two studies regarding the incidence of side effects. We conclude that postoperative analgesia in patients undergoing knee arthroscopy under local anaesthesia, but not under bupivacaine spinal anaesthesia, can be improved with a single intraarticular injection of 1 mg morphine.
80例计划接受膝关节镜检查的患者被随机、双盲研究。40例住院过夜患者选择使用0.5%重比重布比卡因进行脊髓麻醉。在关节镜检查结束时，向关节腔内注射1毫克吗啡或生理盐水。另外40例门诊患者选择使用1%利多卡因加肾上腺素进行局部麻醉。在关节镜检查结束时，同样向关节腔内注射1毫克吗啡或生理盐水。作为急救药物，脊髓麻醉患者接受0.14毫克/千克静脉注射羟考酮或口服100毫克酮洛芬，局部麻醉患者接受口服100毫克酮洛芬。两个脊髓麻醉组术后额外镇痛的需求几乎相似。接受局部麻醉并关节腔内注射吗啡的患者术后所需酮洛芬剂量（22剂）少于对照组（39剂）（P<0.05）。吗啡组镇痛持续时间略长于对照组（无统计学意义）。在两项研究中，吗啡组患者和对照组患者在副作用发生率方面没有差异。我们得出结论，在局部麻醉而非布比卡因脊髓麻醉下接受膝关节镜检查的患者，单次关节腔内注射1毫克吗啡可改善术后镇痛效果。
