Allen G C, St Amand M A, Lui A C, Johnson D H, Lindsay M P
Department of Anesthesia, College of Medicine, Pennsylvania State University, Hershey 17033.
Anesthesiology. 1993 Sep;79(3):475-80. doi: 10.1097/00000542-199309000-00010.
Postarthroscopy analgesia has been provided with intraarticular bupivacaine, but the duration of analgesia may be only a few hours. More recently, longer-lasting analgesia has been achieved using intraarticular morphine, although the onset of analgesia may be delayed. The combination of intraarticular morphine and bupivacaine has been suggested as an ideal analgesic after knee arthroscopy.
One hundred and twenty ASA Physical Status 1-2 outpatients, age 18-60 yr, having knee arthroscopy, were randomized into one of four treatment groups. Exclusion criteria included relevant drug allergy, extensive debridement or synovectomy, arthrotomy, postoperative intraarticular drainage, tracheal intubation, and patient refusal. All patients received general anesthesia with intravenous fentanyl, propofol, N2O, O2, and isoflurane. At the end of surgery, before tourniquet release, the following were injected intraarticularly through the arthroscope: group 1, 0.25% bupivacaine; group 2, 1 mg morphine in saline; group 3, 2 mg morphine in saline; and group 4, 1 mg morphine in 0.25% bupivacaine. The volume injected was 30 ml, and all solutions contained 1:200,000 epinephrine. Postoperative analgesia was provided with intravenous fentanyl and/or oral acetaminophen/codeine, and was recorded for 24 h. Visual analog pain scale (VAPS) scores and the McGill Pain Questionnaire (MPQ) were performed hourly from 1-6 h, and at 24 h postoperatively.
Visual analog pain scale and MPQ scores were lowest in groups 1 and 4 at 1-6 h, but at 24 h, VAPS scores were lowest in groups 2, 3, and 4. Analgesic requirements were lower for the first 12 h in groups 1 and 4, but no difference was seen between groups over the 24-h study period. No adverse effects were noted.
Morphine, 1 mg intraarticular, in 30 ml 0.25% bupivacaine, with 1:200,000 epinephrine, may provide superior postoperative analgesia for up to 24 h versus bupivacaine or morphine alone.
关节镜检查后的镇痛一直采用关节腔内注射布比卡因，但镇痛时间可能仅为几个小时。最近，关节腔内注射吗啡可实现更持久的镇痛，尽管镇痛起效可能会延迟。关节腔内注射吗啡和布比卡因的联合用药被认为是膝关节镜检查后理想的镇痛方法。
120例年龄在18至60岁、ASA身体状况为1 - 2级的膝关节镜检查门诊患者被随机分为四个治疗组之一。排除标准包括相关药物过敏、广泛清创或滑膜切除术、关节切开术、术后关节腔内引流、气管插管以及患者拒绝。所有患者均接受静脉注射芬太尼、丙泊酚、N₂O、O₂和异氟烷的全身麻醉。手术结束时，在松开止血带前，通过关节镜向关节腔内注射以下药物：第1组，0.25%布比卡因；第2组，盐水中含1 mg吗啡；第3组，盐水中含2 mg吗啡；第4组，0.25%布比卡因中含1 mg吗啡。注射体积为30 ml，所有溶液均含有1:200,000肾上腺素。术后镇痛采用静脉注射芬太尼和/或口服对乙酰氨基酚/可待因，并记录24小时。术后1至6小时及24小时每小时进行视觉模拟疼痛量表（VAPS）评分和麦吉尔疼痛问卷（MPQ）评估。
术后1至6小时，第1组和第4组的视觉模拟疼痛量表和MPQ评分最低，但在24小时时，第2组、第3组和第4组的VAPS评分最低。第1组和第4组在最初12小时的镇痛需求较低，但在24小时的研究期间各组之间未见差异。未观察到不良反应。
与单独使用布比卡因或吗啡相比，30 ml含1:200,000肾上腺素的0.25%布比卡因中关节腔内注射1 mg吗啡可提供长达24小时的更优术后镇痛效果。
