title: The effect of intraarticular injection of morphine and bupivacaine on postarthroscopic pain control.
abstract: This study sought to compare the effects of morphine, bupivacaine, and saline injected into the knee after arthroscopic surgery. In a double-blind, randomized trial, 124 patients received either bupivacaine, morphine, bupivacaine and morphine, or saline at the completion of surgery. Postoperative pain was assessed with a 100-mm visual analog pain scale. Analgesic requirements were calculated, and weightbearing status was recorded. We found that morphine alone injected intraarticularly at the completion of arthroscopic knee surgery had no significant effect on postoperative pain, need for supplemental analgesia, or weightbearing status. Patients receiving morphine in combination with bupivacaine did not demonstrate any statistically significant improvement over those receiving bupivacaine alone. Therefore, our results failed to show any beneficial effect of morphine used for postoperative analgesia, either alone or in combination with bupivacaine. The overall pattern in all patients demonstrated decreased pain scores, decreased analgesic use, and increased weightbearing status as the observation period progressed. Finally, preoperative pain was correlated with pain at discharge, indicating that the most significant predictor of postoperative pain was preoperative level of discomfort.
authors.affiliation: Kerlan-Jobe Orthopaedic Clinic, Centinela Hospital, Inglewood, California.
authors.forename: P A
authors.initials: PA
authors.lastname: Ruwe
authors.forename: I
authors.initials: I
authors.lastname: Klein
authors.forename: C L
authors.initials: CL
authors.lastname: Shields
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001182:Arthroscopy; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007718:Knee Injuries / Q000601:surgery*; D008124:Locomotion; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D012044:Regression Analysis; D016896:Treatment Outcome; D016474:Weight-Bearing
chemical_list: D009020:Morphine; D002045:Bupivacaine