title: Intraarticular morphine and bupivacaine reduces postoperative pain after rotator cuff repair.
abstract: OBJECTIVE
  To determine whether intraarticular injection of morphine, fentanyl, or sufentanil added to bupivacaine provided pain control after open rotator cuff repair.
  
  
  METHODS
  These data were collected as a prospective, randomized, blinded observer study. All patients received a standard interscalene anesthetic with 1.4% mepivacaine with 1:200,000 epinephrine. At the conclusion of surgery, they received an intraarticular injection after the shoulder capsule was closed. Patients were randomized into 4 groups. All received 20 mL of 0.25% bupivacaine: group 1, plain; group 2, with 1 mg of morphine added; group 3, with 50 microg of fentanyl added; and group 4, with 10 microg of sufentanil added. Pain scores in the postanesthesia care unit were evaluated at 0, 30, 60, 90, 120, and 240 minutes and at 4-hour intervals postoperatively using a visual analogue scale. Breakthrough pain was managed with morphine, via patient controlled analgesia pump.
  
  
  RESULTS
  Thirty-nine patients were entered into the study. Pain scores at 2 hours and beyond were lowest in group 2. Total morphine utilization was significantly lower for the first 24 hours in group 2.
  
  
  CONCLUSIONS
  Intraarticular injection of the shoulder with 0.25% bupivacaine and 1 mg morphine at the conclusion of surgery provided pain control and diminished morphine used in the first 24 hours after open rotator cuff repair. Fentanyl and sufentanil did not improve the analgesia over that achieved with bupivacaine alone.
authors.affiliation: Department of General Anesthesiology, The Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195, USA. tetzlaf@ccf.org
authors.forename: J E
authors.initials: JE
authors.lastname: Tetzlaff
authors.forename: J
authors.initials: J
authors.lastname: Brems
authors.forename: J
authors.initials: J
authors.lastname: Dilger
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular; D009020:Morphine / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D017006:Rotator Cuff / Q000601:surgery*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine