Söderlund A, Westman L, Ersmark H, Eriksson E, Valentin A, Ekblom A
Department of Anesthesiology and Intensive Care, Karolinska Hospital, Stockholm, Sweden.
Acta Anaesthesiol Scand. 1997 Jan;41(1 Pt 1):6-11. doi: 10.1111/j.1399-6576.1997.tb04606.x.
It has recently been reported that morphine given in low doses intra-articularly can produce significant analgesia in patients undergoing arthroscopic knee joint surgery. Data are lacking on the effect of other opioids using a local approach for drug delivery. We studied the analgesic effect of intra-articular opioids in 70 patients, divided into 7 groups, subjected to arthroscopic knee surgery in general anesthesia. The dimension of the study was based on a power of 0.8 to detect a 25% difference in pain intensity between those receiving opioids locally versus systemically (alpha = 0.05 and beta = 0.20). Following surgery, but before terminating anesthesia, the patients received one of the following combinations: 1 mg morphine intra-articularly (i.art.) + saline intramuscularly (i.m.), 10 mg pethidine i.art + saline i.m., or 10 micrograms fentanyl i.art + saline i.m. In three additional groups the three opioids were given i.m. and saline given i.art. An additional control group received saline i.art. + i.m. We did not find any significant difference between the groups considering postoperative pain intensity, need for analgesics or considering time to standing/walking or to discharge, analysing each opioid independently. There was, however, a tendency for pethidine i.art. to produce the lowest pain scores both at rest and during movement (P = 0.06). If analysing the results with regards to if opioids were given intra-articularly or systemically, not considering the type of opioid given, we did however, find a significantly lower total sum of pain scores at movement following local administration (P < 0.05). No specific side-effects were detected. We conclude that pethidine given intra-articularly merits further investigation with respect to postoperative analgesia following the activation of peripheral opioid mechanisms.
最近有报道称，关节腔内注射低剂量吗啡可使接受膝关节镜手术的患者产生显著的镇痛效果。目前缺乏关于其他阿片类药物采用局部给药方式效果的数据。我们研究了关节腔内注射阿片类药物对70例患者的镇痛效果，这些患者分为7组，在全身麻醉下接受膝关节镜手术。该研究的规模基于0.8的检验效能，以检测局部使用阿片类药物与全身使用阿片类药物的患者在疼痛强度上25%的差异（α = 0.05，β = 0.20）。手术后，但在麻醉结束前，患者接受以下组合之一：关节腔内注射1 mg吗啡 + 肌肉注射生理盐水，关节腔内注射10 mg哌替啶 + 肌肉注射生理盐水，或关节腔内注射10 μg芬太尼 + 肌肉注射生理盐水。另外三组中，三种阿片类药物通过肌肉注射给药，关节腔内注射生理盐水。另一个对照组接受关节腔内注射生理盐水 + 肌肉注射生理盐水。在独立分析每种阿片类药物时，我们发现各治疗组在术后疼痛强度、镇痛药物需求或站立/行走时间或出院时间方面均无显著差异。然而，关节腔内注射哌替啶在静息和运动时均有产生最低疼痛评分的趋势（P = 0.06）。如果不考虑所给阿片类药物的类型，仅分析阿片类药物是通过关节腔内给药还是全身给药的结果，我们发现局部给药后运动时的疼痛评分总和显著更低（P < 0.05）。未检测到特定的副作用。我们得出结论，关节腔内注射哌替啶在激活外周阿片类机制后的术后镇痛方面值得进一步研究。
