title: Reconstruction of the anterior cruciate ligament: comparison of analgesia using intrathecal morphine, intra-articular morphine and intra-articular levobupivacaine.
abstract: OBJECTIVE
  To compare the analgesic effect of intra-articular administration of morphine and levobupivacaine (separately or in combination) with intrathecal administration of morphine in patients undergoing anterior cruciate ligament (ACL) reconstruction using autologous grafts from the patellar tendon.
  
  
  METHODS
  This was a retrospective analysis on data gathered from the medical files of 60 patients aged 20 to 50 years who underwent knee video arthroscopy for ACL reconstruction. The patients were divided into four groups of 15 individuals (A, B, C and D) according to the agent administered into the joint and around the incision: 20 mL of saline solution with 5 mg of morphine in A; 20 mL of 0.5% levobupivacaine solution in B; 10 mL of solution with 2.5 mg of morphine plus 10 mL of 0.5% levobupivacaine solution in C; and morphine administered intrathecally in D.
  
  
  RESULTS
  All the groups presented low pain scores during the first 12 h after the surgery. Groups B and C presented significantly greater pain scores than shown by group D (control), 24 h after the surgery. There was no statistical difference in pain scores between group A and group D.
  
  
  CONCLUSIONS
  The patients in group A presented analgesia comparable to that of the patients in group D, whereas the procedure of group C was no capable of reproducing the analgesic effect observed in group D, as observed 24 h after the surgery. Further studies are needed in order to show the exact mechanism of action, along with the ideal dose and concentration for applying opioids to joints.
authors.affiliation: Serviço de Ortopedia e Traumatologia de Ribeirão Preto, Ribeirão Preto, SP, Brazil.
authors.forename: Leandro Queiroz
authors.initials: LQ
authors.lastname: Pinheiro
authors.affiliation: Serviço de Ortopedia e Traumatologia de Ribeirão Preto, Ribeirão Preto, SP, Brazil.
authors.forename: Edmundo
authors.initials: E
authors.lastname: Neri Junior
authors.affiliation: Serviço de Ortopedia e Traumatologia de Ribeirão Preto, Ribeirão Preto, SP, Brazil.
authors.forename: Reginaldo Mendonça
authors.initials: RM
authors.lastname: Fernandes
authors.affiliation: Serviço de Ortopedia e Traumatologia de Ribeirão Preto, Ribeirão Preto, SP, Brazil.
authors.forename: Rodrigo Tavares
authors.initials: RT
authors.lastname: Cardozo
authors.affiliation: Cooperativa dos Anestesiologistas de Ribeirão Preto, Ribeirão Preto, SP, Brazil.
authors.forename: Priscila Rodrigues
authors.initials: PR
authors.lastname: Rezende
keywords: Anesthesia; Anterior cruciate ligament/surgery; Arthroscopy; Morphine/administration and dosage