title: Intra-synovial ropivacaine and morphine for pain relief after total knee arthroplasty: a prospective, randomized, double blind study.
abstract: OBJECTIVE
  Several analgesic techniques are available for pain management after a major operation.
  
  
  METHODS
  From December 2005 to February 2006, a prospective, double-blind study was performed involving 90 patients who had undergone a total knee arthroplasty. Patients were randomly divided into three equal groups (n=30). Demographic data, including age, height, weight, knee score, visual analogue scale (VAS), and range of flexion were evaluated preoperatively. Before wound closure, patients were given intra-synovial injections of the following solutions: patients in group I received 40mL of 300mg ropivacaine with 1:200,000 epinephrine and 5mg morphine; patients in Group II received 40mL of 300mg ropivacaine with epinephrine; and patients in Group III received 50mL normal saline as a control. All patients received an epidural patient-controlled analgesia (PCA) for 24 postoperative hours. Analgesic efficacy was evaluated using the VAS at intervals of 2, 4, 6, 12, 24, 32, 40, and 48 hours postoperatively. During this period, the side effects, the dosage of rescue analgesia required, and the range of knee flexion were recorded for each group.
  
  
  RESULTS
  There were no significant differences among the three groups with regards to the VAS and the required dose of rescue analgesia (p > 0.05). None of the groups demonstrated significant differences in the range of knee flexion and the incidence of postoperative nausea and emesis (p > 0.05).
  
  
  CONCLUSIONS
  Therefore, we found that ropivacaine, alone or with morphine, injected into the synovial tissue, along with an epidural PCA has no additional benefits in pain control after a total knee arthroplasty.
authors.affiliation: Department of Orthopaedic Surgery, Yonsei University College of Medicine, 134 Sinchon-Dong, Seodaemun-Gu, Seoul, Korea. cdhan@yumc.yonsei.ac.kr
authors.forename: Chang-Dong
authors.initials: CD
authors.lastname: Han
authors.forename: Doo-Hyung
authors.initials: DH
authors.lastname: Lee
authors.forename: Ick Hwan
authors.initials: IH
authors.lastname: Yang
mesh_terms: D000368:Aged; D000577:Amides / Q000008:administration & dosage / Q000627:therapeutic use*; D000698:Analgesia; D000704:Analysis of Variance; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000601:surgery; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use*; D010003:Osteoarthritis / Q000601:surgery; D010149:Postoperative Pain / Q000188:drug therapy*; D011183:Postoperative Complications / Q000517:prevention & control*; D016059:Range of Motion, Articular; D000077212:Ropivacaine; D013583:Synovial Membrane
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine