title: Increased numbers of opioid expressing inflammatory cells do not affect intra-articular morphine analgesia.
abstract: BACKGROUND
  Both locally expressed beta-endorphin (END) and low doses of morphine relieve pain within inflamed knee joints. Here we examined whether enhanced inflammation and END expression within the synovial tissue of patients undergoing arthroscopic knee surgery might shift the analgesic dose-response curve of intra-articular (i.a.) morphine.
  
  
  METHODS
  Following IRB approval and informed consent, patients were randomly assigned to the following i.a. treatments at the end of surgery: group I (n=39), isotonic saline; group II (n=40), 1 mg morphine hydrochloride; group III (n=48), 2 mg morphine hydrochloride; group IV (n=39), 4 mg morphine hydrochloride. Postoperative pain intensity was assessed by the visual analogue scale (VAS), by the time to first analgesic request and by the supplemental piritramide consumption. Synovial specimens from each patient were stained for the presence of inflammatory cells and END and were discriminated into groups with low versus high numbers of these cells. Differences between groups were statistically analyzed by chi(2), anova and mancova where appropiate.
  
  
  RESULTS
  Patient characteristics and VAS scores did not differ between groups. Total postoperative piritramide consumption decreased and the time to first analgesic request increased significantly with increasing doses of i.a. morphine (P<0.05, anova and linear regression). These dose-response relationships were not different between patients with low versus high numbers of inflammatory and END-containing synovial cells (P>0.05, mancova).
  
  
  CONCLUSIONS
  The dose-response relationship of i.a. morphine analgesia is not shifted by enhanced inflammation and END expression within synovial tissue. Thus, the presence of END within inflamed synovial tissue does not seem to interfere with i.a. morphine analgesia.
authors.affiliation: Abteilung für Anaesthesiologie und Intensivmedizin, LKH Klagenfurt, St. Veiter-Strasse 47, A-9020 Klagenfurt, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Likar
authors.forename: S A
authors.initials: SA
authors.lastname: Mousa
authors.forename: G
authors.initials: G
authors.lastname: Philippitsch
authors.forename: H
authors.initials: H
authors.lastname: Steinkellner
authors.forename: W
authors.initials: W
authors.lastname: Koppert
authors.forename: C
authors.initials: C
authors.lastname: Stein
authors.forename: M
authors.initials: M
authors.lastname: Schäfer
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001182:Arthroscopy; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000378:metabolism / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement / Q000379:methods; D010892:Pirinitramide / Q000008:administration & dosage; D011957:Receptors, Opioid / Q000378:metabolism*; D013585:Synovitis / Q000378:metabolism / Q000473:pathology*
chemical_list: D000701:Analgesics, Opioid; D011957:Receptors, Opioid; D010892:Pirinitramide; D009020:Morphine