Intra-articular morphine versus bupivacaine for knee motion among patients with osteoarthritis
randomized double-blind clinical trial
Keywords:
Analgesia, Morphine, Bupivacaine, Osteoarthritis, KneeAbstract
CONTEXT AND OBJECTIVE: Osteoarthritis causes pain and disability in a high percentage of elderly people. The aim of the present study was to assess the effi cacy of intra-articular morphine and bupivacaine on the joint fl exion and extension angles of patients with knee osteoarthritis. DESIGN AND SETTING: A randomized doubleblind study was performed at a pain clinic of Universidade Federal de São Paulo. METHODS: Thirty-nine patients with pain for more than three months, of intensity greater than three on a numerical scale (zero to 10), were included. G1 patients received 1 mg (1 ml) of morphine diluted in 9 ml of saline, intra-articularly, and G2 patients received 25 mg (10 ml) of 0.25% bupivacaine without epinephrine. Pain was assessed on a numerical scale and knee fl exion and extension angles were measured after administration of the drugs at rest and during movement. The total amount of analgesic supplementation using 500 mg doses of paracetamol was also determined. RESULTS: No significant difference in pain intensity was observed between G1 and G2. Signifi cant decreases in pain at rest and during movement and signifi cant increases in mean fl exion and extension angles were observed in both groups, with no signifi cant difference between the two groups. The mean total amount of paracetamol used over a seven-day period was 3578 mg in G1 and 5333 mg in G2 (P = 0.2355; Mann-Whitney test). CONCLUSION: The analgesic effects of 1 mg of morphine and 25 mg of 0.25% bupivacaine were similar among patients with osteoarthritis of the knee.
Downloads
References
AGS Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc. 2002;50(6 Suppl):S205-24.
McCarthy C, Cushnaghan J, Dieppe P. Osteoarthritis. In: Wall PD, Melzack R, Bonica JJ, editors. Textbook of pain. 3rd ed. Edinburgh: Churchill Livingstone; 1994. p. 387-96.
Kellgren JH, Lawrence JS. Radiological assessment of osteo- arthrosis. Ann Rheum Dis. 1957;16(4):494-502.
Thorén P, Floras JS, Hoffmann P, Seals DR. Endorphins and exercise: physiological mechanisms and clinical implications. Med Sci Sports Exerc. 1990:22(4):417-28.
Chan ST. Intra-articular morphine and bupivacaine for pain relief after therapeutic arthroscopic knee surgery. Singapore Med J. 1995;36(1):35-7.
Ritter MA, Koehler M, Keating EM, Faris PM, Meding JB. Intra-articular morphine and/or bupivacaine after total knee replacement. J Bone Joint Surg Br. 1999;81(2):301-3.
Reuben SS, Sklar J, El-Mansouri M. The preemptive analgesic ef- fect of intraarticular bupivacaine and morphine after ambulatory arthroscopic knee surgery. Anesth Analg. 2001;92(4):923-6.
Stein C. Peripheral mechanisms of opioid analgesia. Anesth Analg. 1993;76(1):182-91.
Khoury GF, Garland DE, Stein C. Intraarticular opioid-local anesthetic combinations for chronic joint pain. Middle East J Anesthesiol. 1994;12(6):579-85.
Stein A, Yassouridis A, Szopko C, Helmke K, Stein C. Intraar- ticular morphine versus dexamethasone in chronic arthritis. Pain. 1999;83(3):525-32.
Creamer P, Hunt M, Dieppe P. Pain mechanisms in osteoarthritis of the knee: effect of intraarticular anesthetic. J Rheumatol. 1996;23(6):1031-6.
Peloso PM. Opioid therapy for osteoarthritis of the hip and knee: use it or lose it? J Rheumatol. 2001;28(1):6-11.
Sowers M. Epidemiology of risk factors for osteoarthritis: systemic factors. Curr Opin Rheumatol. 2001;13(5):447-51.
Coderre TJ, Katz J, Vaccarino AL, Melzack R. Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain. 1993;52(3):259-85.
Woolf CJ. Somatic pain--pathogenesis and prevention. Br J Anaesth. 1995;75(2):169-76.
Papathanassiou NP. Intra-articular use of tenoxicam in degenerative osteoarthritis of the knee joint. J Int Med Res. 1994;22(6):332-7.
Chan ST. Intra-articular morphine and bupivacaine for pain relief after therapeutic arthroscopic knee surgery. Singapore Med J. 1995;36(1):35-7.
Stein C, Comisel K, Haimerl E, et al. Analgesic effect of in- traarticular morphine after arthroscopic knee surgery. N Engl J Med. 1991;325(16):1123-6.
Dalsgaard J, Felsby S, Juelsgaard P, Froekjaer J. Low-dose intra-articular morphine analgesia in day case knee arthros- copy: a randomized double-blinded prospective study. Pain. 1994;56(2):151-4.
