Intra-articular clonidine analgesia after knee arthroscopy.
Recently, it was suggested that peripherally-mediated analgesia can be accomplished by the intra-articular delivery of the mu-opioid morphine or of the a2-agonist clonidine. This clinical study assesses the potential peripheral analgesic effect of the combination of morphine and clonidine after intra-articular administration. Sixty patients (American Society of Anesthesiologists status I or II) undergoing arthroscopic repair of the knee during general anaesthesia were randomized to receive after operation, in a double-blind manner, either 1 mg morphine intra-articularly (group 1); 150 microg clonidine intra-articularly (group 2); or 1 mg morphine + 150 microg clonidine intra-articularly (group 3); or normal saline intra-articularly (group 4) in a volume of 30 mL, respectively. Visual analogue pain scores (VAS), duration of analgesia as defined by first demand for supplemental analgesics, subsequent 24 h consumption of postoperative supplementary analgesics, and patient satisfaction were evaluated. Co-administration of morphine + clonidine (group 3) resulted in a significant VAS reduction at 2 h after injection compared with the other groups. There was a tendency towards a lower need for supplementary rescue analgesia and towards a more prolonged analgesia in group 3 (211 min +/- 224 min SD) compared with group 1 (173 min +/- 197 min SD) and group 4 (91 min +/- 21 min SD). More patients were very satisfied with the postoperative analgesic regimen receiving the combination of morphine and clonidine (group 3) at 24 h postoperatively. Thus we conclude, that the peripheral co-delivery of an opioid and an a2-agonist will result in improved postoperative pain relief, when compared with each single agent given alone.
Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Westfälische Wilhelms-Universität Münster, Germany.
H
H
Buerkle
V
V
Huge
M
M
Wolfgart
J
J
Steinbeck
N
N
Mertes
H
H
Van Aken
T
T
Prien
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage* / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage* / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000768:Anesthesia, General; D001182:Arthroscopy; D003000:Clonidine / Q000008:administration & dosage* / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007717:Knee / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy*
D000316:Adrenergic alpha-Agonists; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D009020:Morphine; D003000:Clonidine