title: Intra-synovial, compared to intra-articular morphine provides better pain relief following knee arthroscopy menisectomy.
abstract: OBJECTIVE
  To evaluate the analgesic effect of morphine 1 mg administered into the synovial tissue and the outer third of the meniscus after knee arthroscopy.
  
  
  METHODS
  In a prospective, double-blind, randomized study, 60 patients who required elective knee arthroscopy were assigned to two groups: Group A consisted of 30 patients who received a direct injection of morphine 1 mg into either the synovial tissue or the outer third of the meniscus following menisectomy. Group B consisted of 30 patients who received a direct injection of NaCl 0.9% 1 mL into the synovial tissue or the outer third of the meniscus following menisectomy. At the end of the operation Group A received an intra-articular injection of NaCl 0.9% 1 mL and bupivacaine 0.5% 10 mL and Group B received an intra-articular injection of morphine 1 mg and bupivacaine 0.5% 10 mL. Analgesic effect was evaluated by pain intensity (visual analogue scale; VAS) and analgesic requirements (paracetamol) during the first one, three, six, 12, 24, and 48 hr postoperatively.
  
  
  RESULTS
  There was no significant difference between the two groups within the first six hours and after 24 hr following the operation regarding VAS score and analgesic requirements. At 12 and 24 hr following the operation, the VAS score and the analgesic requirements were significantly higher in Group B compared to Group A (P <0.01 and P <0.01, respectively). No patient developed side effects.
  
  
  CONCLUSIONS
  We conclude that direct morphine injection into the synovia or the outer third of the meniscus provided better pain relief than intra-articular morphine after knee arthroscopy.
authors.affiliation: Department of Orthopaedic Surgery, Carmel Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa Israel. kaligan@netvision.net.il
authors.forename: Mordechai
authors.initials: M
authors.lastname: Kligman
authors.forename: Alex
authors.initials: A
authors.lastname: Bruskin
authors.forename: Jorge
authors.initials: J
authors.lastname: Sckliamser
authors.forename: Rony
authors.initials: R
authors.lastname: Vered
authors.forename: Moshe
authors.initials: M
authors.lastname: Roffman
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use*; D001182:Arthroscopy; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007267:Injections; D007270:Injections, Intra-Articular; D007717:Knee / Q000601:surgery*; D008297:Male; D009020:Morphine / Q000008:administration & dosage* / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D013583:Synovial Membrane
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine