Opioid in Peripheral Analgesia: Intra-articular Morphine for Pain Control after Arthroscopic Knee Surgery

類鴉片藥物之周邊鎮痛作用：膝關節手術後關節內注射嗎啡的止痛作用

劉康(Kang Liu) ； 王志中(Jhi-Joung Wang) ； 何善台(Shung-Tai Ho) ； 廖文進(Wen-Jinn Liaw) ； 賈元一(Yuan-Yi Chia)

《Acta Anaesthesiologica Sinica》 33卷4期 (1995/12) Pp. 217-221

摘要

Background: Some authors reported that a small dose of intra-articular morphine (1-5 mg) injection provided a potent and long-acting analgesic effect on pain after arthroscopic knee surgery. However, many in other reports did not agree to this result. Therefore, the characteristic of the analgesic effect of intra-articular morphine is worth evaluation. In order to rule out the systemic action of intra-articular morphine, we designed a study to compare the efficacy of 3 mg intra-articular morphine with that of 3 mg intravenous morphine in providing analgesia after arthroscopic knee surgery. Methods: Sixty patients undergoing arthroscopic knee surgery under spinal anesthesia were randomly divided into two groups (n=30, each). At the end of surgery, group 1 received 3 mg intra-articular morphine in 15 ml isotonic saline and intravenous isotonic saline 10 ml; group 2 received 15 ml intra-articular isotonic saline and 3 mg intravenous morphine in 10 ml isotonic saline. Postoperative pain was evaluated using visual analogue scale (VAS) during an active or passive flexion of the operated knee joint. Also, additional analgesic consumption requested by patient postoperatively (morphine, 2 mg, iv, each) was recorded. Results: Pain scores were lower in group 1 than in group 2 from 4 to 36 h postoperatively (Mann-Whitney rank-sum test). Also, the consumption of supplemental analgesic morphine was lower in group 1 than in group 2 from 6 to 36 h post-operatively. Conclusions: Intra-articular morphine (3 mg) provided long-lasting analgesia from 6 to 36 h postoperatively and this effect was not due to systemic absorption of morphine.

關鍵字

Opioid: morphine ； Injections: intra-articular, intravenous

並列摘要

背景：有些作者指出在膝關節手術後，小劑量的嗎啡（1－5毫克）經由膝關節腔注射可以提供一個長效的術後止痛。而卻有些學者持反對意見。本研究的目的在比較膝關節腔內注射嗎啡3毫克或經靜脈注射嗎啡3毫克之止痛效果。以瞭解是否膝關節腔注射嗎啡所生成之止痛作用是經由全身吸收所致。方法：六十位接受膝關節手術之病患依隨機分為兩組，每組30人。在手術結束後，第一組接受膝關節腔注射嗎啡3毫克及靜脈注射生理食鹽水；第二組接受膝關節腔內注射生理食鹽水及靜脈注射嗎啡3毫克。手術後疼痛以視覺類比分數來評估當病患主動或被動彎曲膝關節時之疼痛情形，並記錄病人額外要求給予止痛劑（每次嗎啡2毫克）之數量。結果：本研究結果顯示疼痛分數在手術後4到36小時間第一組比第二組低。同時，在手術後6到36小時間第一組病患消耗較少量之額外嗎啡注射。結論：在膝關節鏡手術後經膝關節腔內給予嗎啡3毫克，可以提供一個長效的止痛作用，其作用期間為手術後6到36小時；而靜脈給予嗎啡則無法達到此種長效止痛作用。因此，我們認為經膝關節腔給予嗎啡所生成之止痛作用乃非經由全身吸收所造成。

並列關鍵字

類鴉片藥物：嗎啡 ； 注射：關節內，靜脈