title: Intra-articular glucocorticoid, bupivacaine and morphine reduces pain, inflammatory response and convalescence after arthroscopic meniscectomy.
abstract: Convalescence after arthroscopic meniscectomy is dependent on pain and the inflammatory response. The aim of the study was therefore to investigate the effect of intra-articular bupivacaine + morphine + methylprednisolone versus bupivacaine + morphine or saline on postmeniscectomy pain, mobilisation and convalescence. In a double-blind randomized study 60 patients undergoing arthroscopic meniscectomy were allocated to intra-articular saline, intra-articular bupivacaine 150 mg + morphine 4 mg or the same dose of bupivacaine + morphine + intra-articular methylprednisolone 40 mg. All patients were instructed to resume normal activities immediately after operation. Pain during movement and walking, leg muscle force and joint effusion, use of crutches and duration of sick leave were assessed. Combined bupivacaine and morphine significantly reduced pain, time of immobilisation and duration of convalescence. Addition of methylprednisolone further reduced pain, use of additional analgesics, joint swelling and convalescence, improved muscle function and prevented the inflammatory response (acute phase protein) (P < 0.05). A multimodal analgesic and anti-inflammatory treatment may enhance post-arthroscopic convalescence, which depends on the trauma induced inflammatory response and pain.
authors.affiliation: Department of Orthopaedic Surgery, Hjørring Hospital, DK-9800 Hjørring, Denmark Department of Surgical Gastroenterology, Hvidovre University Hospital, DK-2650 Hvidovre, Denmark.
authors.forename: Sten
authors.initials: S
authors.lastname: Rasmussen
authors.forename: Allan S
authors.initials: AS
authors.lastname: Larsen
authors.forename: Søren T
authors.initials: ST
authors.lastname: Thomsen
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001182:Arthroscopy; D002045:Bupivacaine / Q000008:administration & dosage* / Q000627:therapeutic use; D003289:Convalescence; D004311:Double-Blind Method; D004338:Drug Combinations; D004724:Endoscopy; D005260:Female; D006801:Humans; D007249:Inflammation / Q000188:drug therapy; D007270:Injections, Intra-Articular; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery*; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy*; D011239:Prednisolone / Q000008:administration & dosage* / Q000627:therapeutic use; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D004338:Drug Combinations; D009020:Morphine; D011239:Prednisolone; D002045:Bupivacaine