title: No additional analgesic effect of intra-articular morphine or bupivacaine compared with placebo after elective knee arthroscopy.
abstract: BACKGROUND
  Intra-articular pain prophylaxis is a controversial measure, adding costs although the benefits are still disputed. We wanted to evaluate the effects of intra-articular opioid or local anaesthesia or a combination of the two on postoperative analgesia and analgesic consumption after elective knee arthroscopy.
  
  
  METHODS
  107 patients with little or no preoperative pain and a minor surgical procedure were studied in a prospective, randomized double-blind design. The patients received midazolam 0.03 mg/kg intravenously before induction of general anaesthesia with fentanyl 1-2 micrograms/kg and propofol 2.0 mg/kg intravenously. Anaesthesia was maintained by a total intravenous technique with propofol infusion supplemented with alfentanil 10 micrograms/kg when needed. The patients breathed oxygen/ air through a laryngeal mask. By the end of the surgery they received 20 ml of test drug into the knee-joint: Group I (BM): 20 ml of bupivacaine 2.5 mg/ml with 3 mg of morphine; Group II (B): 20 ml of bupivacaine 2.5 mg/ml; Group III (M): 20 ml isotonic saline with 3 mg morphine; Group IV (P): 20 ml of isotonic saline (placebo).
  
  
  RESULTS
  There were no significant differences between the groups in: time to first analgesic administered, analgesic consumption during the pre-or post-discharge period, nausea, somnolence, side-effects or postoperative pain perception during the first week.
  
  
  CONCLUSIONS
  Intra-articular administration of morphine or bupivacaine is not indicated after elective knee-arthroscopy in patients with minor pre-operative pain and a small surgical trauma.
authors.affiliation: Dept. of Anaesthesia, Ullevaal University Hospital, Oslo, Norway.
authors.forename: V
authors.initials: V
authors.lastname: Aasbø
authors.forename: J C
authors.initials: JC
authors.lastname: Raeder
authors.forename: B
authors.initials: B
authors.lastname: Grøgaard
authors.forename: O
authors.initials: O
authors.lastname: Røise
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage*; D001182:Arthroscopy; D002045:Bupivacaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D004724:Endoscopy; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies
chemical_list: D000700:Analgesics; D009020:Morphine; D002045:Bupivacaine