title: Effect of preemptive intra-articular morphine and ketamine on pain after arthroscopic rotator cuff repair: a prospective, double-blind, randomized controlled study.
abstract: BACKGROUND
  Rotator cuff tear is a leading etiology of shoulder pain and disability. Surgical treatment is indicated in patients with persistent pain who fail a trial of non-surgical treatment. Pain reduction following rotator cuff repair, particularly within the first 24-48 h, is a major concern to both doctors and patients. This study aimed to compare the postoperative antinociceptive additive effects of pre-incisional intra-articular (IA) ketamine when combined with morphine with two times the dose of morphine or saline.
  
  
  METHODS
  In this prospective, randomized, double blind, controlled trial patients undergoing arthroscopic rotator cuff tear repair (ARCR) under general anesthesia were enrolled. Patients were randomly assigned to one of the three intervention groups. Twenty minutes prior to incision, morphine (20 mg/10 ml), ketamine (50 mg + morphine 10 mg/10 ml), or saline (0.9 % 10 ml) (n = 15/group), were administered to all patients. First 24 h postoperative analgesia consisted of intravenous patient controlled analgesia (IV-PCA) morphine and oral rescue paracetamol 1000 mg or oxycodone 5 mg. 24-h, 2-week and 3-month patient rated pain numeric rating scale (NRS) and analgesics consumption were documented.
  
  
  RESULTS
  Patients' demographic and perioperative data were similar among all groups. The 24-h and the 2-week NRSs were significantly (p < 0.05) lower in both treatment groups compared to placebo, but were not significantly different between the two intervention groups. PCA-morphine and oral analgesics were consumed similarly among the groups throughout the study phases.
  
  
  CONCLUSIONS
  Pre-incisional intra-articular morphine reduced pain in the first 2 weeks after arthroscopic rotator cuff repair. Further research is warranted to elucidate the optimal timing and dosing of IA ketamine and morphine for postoperative analgesic effects.
authors.forename: M
authors.initials: M
authors.lastname: Khashan
authors.forename: O
authors.initials: O
authors.lastname: Dolkart
authors.forename: E
authors.initials: E
authors.lastname: Amar
authors.forename: O
authors.initials: O
authors.lastname: Chechik
authors.forename: Z
authors.initials: Z
authors.lastname: Sharfman
authors.forename: G
authors.initials: G
authors.lastname: Mozes
authors.forename: E
authors.initials: E
authors.lastname: Maman
authors.forename: A  A
authors.initials: A
authors.lastname: Weinbroum
mesh_terms: D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000627:therapeutic use*; D001182:Arthroscopy; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007649:Ketamine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011300:Preoperative Care; D011446:Prospective Studies; D017006:Rotator Cuff / Q000601:surgery*
chemical_list: D000700:Analgesics; D007649:Ketamine; D009020:Morphine