title: Intraarticular patient-controlled regional anesthesia after arthroscopically assisted anterior cruciate ligament reconstruction: ropivacaine/morphine/ketorolac versus ropivacaine/morphine.
abstract: Anterior cruciate ligament reconstruction (ACLR) is associated with moderate to severe postoperative pain. We compared the intraarticular analgesic effects of ropivacaine and morphine with or without ketorolac and the need for rescue IV morphine at rest and during movement in patients undergoing anterior cruciate ligament reconstruction during spinal anesthesia. Thirty-nine patients receiving intraarticular patient-controlled regional analgesia with a 10-mL bolus and a 60-min lockout interval were randomized into 3 groups: the RM group received 0.25% ropivacaine and morphine 0.2 mg/mL; the RMK group received 0.25% ropivacaine, morphine 0.2 mg/mL and ketorolac 1 mg/mL; the P group received saline. Analgesic mixtures were prepared in 100-mL bags and coded. If needed, rescue morphine 2 mg was self-administered IV with 10-min lockout intervals. Pain scores and patient satisfaction were assessed at rest and during movement. There were no significant differences among the groups in pain scores and patient satisfaction. Daily morphine consumption was significantly smaller in the RMK group (8 +/- 8 mg) compared with the RM group (23 +/- 20 mg; P = 0.002) and in both groups compared with control (46 +/- 21 mg; P < 0.001). We conclude that intraarticular patient-controlled regional analgesia provides effective pain relief after anterior cruciate ligament reconstruction. The combination of intraarticular ropivacaine, morphine, and ketorolac was superior to control or to a combination of ropivacaine and morphine.
  
  
  CONCLUSIONS
  This study showed the feasibility and efficacy of intraarticular patient-controlled regional analgesia technique for pain relief after anterior cruciate ligament reconstruction. The combination of intraarticular ropivacaine, morphine, and ketorolac was superior to control or to a combination of ropivacaine and morphine.
authors.affiliation: *Department of Anesthesiology and Intensive Care, †Department of Traumatology, University Medical Center Ljubljana, Slovenia, ‡Department of Anesthesiology, University Hospital Őrebro, Sweden.
authors.forename: Neli
authors.initials: N
authors.lastname: Vintar
authors.forename: Narinder
authors.initials: N
authors.lastname: Rawal
authors.forename: Matjaž
authors.initials: M
authors.lastname: Veselko
mesh_terms: D000293:Adolescent; D000328:Adult; D000577:Amides; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid; D000765:Anesthesia, Conduction; D000779:Anesthetics, Local; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D001182:Arthroscopy; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D020910:Ketorolac; D008297:Male; D008875:Middle Aged; D009020:Morphine; D010147:Pain Measurement; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D019651:Plastic Surgery Procedures; D000077212:Ropivacaine; D013242:Sterilization
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine; D020910:Ketorolac