Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-09-2012 | Knee

The comparison of intraarticular morphine–bupivacaine and tramadol–bupivacaine in postoperative analgesia after arthroscopic anterior cruciate ligament reconstruction

Authors: Habibollah Hosseini, Seyyed Mohammad Jalil Abrisham, Hossein Jomeh, Mohammad Kermani-Alghoraishi, Rahil Ghahramani, Mohammad Reza Mozayan

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2012

Abstract

Purpose

To compare intraarticular morphine–bupivacaine and tramadol–bupivacaine as postoperative analgesics in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction.

Methods

A randomized, double blind, controlled trial study of 60 ASA I–II patients undergoing arthroscopic ACL reconstruction was performed under general anesthesia. Patients were randomly allocated into three groups. The MB group (n = 20) received 10 mg morphine and 0.5% bupivacaine; the TB group (n = 20) received 100 mg tramadol and 0.5% bupivacaine; and the control group (n = 20) received isotonic saline intraarticularly in a total volume of 20 ml after the operation. Postoperative pain was assessed with visual analogue scale (VAS) at 0, 30, 60, 90 min and 2, 4, 6, 12, 24 h being at rest. Analgesic duration as defined was the time of first request for analgesics, the first 24 h analgesic consumption, time to unassisted ambulation, discharge time and incidence of side effects were also evaluated.

Results

The VAS scores at 30, 60, 90 min and 2, 4, 12, 24 h were significantly less in the MB and TB groups in comparison with the control group (P < 0.05); VAS scores also decreased significantly in the MB group compared to the TB group at 2, 4 and 24 h (P < 0.05). Analgesic duration was longer and analgesic consumption was substantially less in the MB group (P < 0.05). Moreover, unassisted ambulation time and discharge time were significantly shorter in the MB group than the TB and control groups (P < 0.05). Side effects were similar among the groups.

Conclusions

Intraarticular morphine–bupivacaine provides effective pain relief, longer analgesic duration, less analgesic requirement, shorter unassisted ambulation and discharge time were compared with intraarticular tramadol–bupivacaine after ACL reconstruction arthroscopy.

Level of evidence

Akinci SB, Saricaoglu F, Atay A, Doral MN, Kanbak M (2003) Analgesic effect of intraarticular tramadol compared to morphine after arthroscopic knee surgery (To the editor). Can J Anaesth 50:423–424PubMedCrossRef

Alagöl A, Çalpur OU, Kaya G, Pamukçu Z, Turan FN (2004) The use of intraarticular tramadol for postoperative analgesia after arthroscopic knee surgery: a comparison of different intraarticular and intravenous doses. Knee Surg Sports Traumatol Arthrosc 12:184–188PubMedCrossRef

Alagol A, Calpur OU, Usar PS, Turan N, Pamukcu Z (2005) Intraarticular analgesia after arthroscopic knee surgery: comparison of neostigmine, clonidine, tenoxicam, morphine and bupivacaine. Knee Surg Sports Traumatol Arthrosc 13:658–663PubMedCrossRef

Allen GC, St Amand MA, Lui AC, Johnson DH, Lindsay MP (1993) Postarthroscoy analgesia with intraarticular bupivacaine/morphine. A randomized clinical trial. Anesthesiology 3:475–480CrossRef

Bamigbade TA, Davidson C, Langford RM, Stamford JA (1997) Actions of tramadol, its enantiomers and principal metabolite, O-desmethyltramadol, on serotinine (5-HT) efflux and uptake in the rat dorsal raphe nucleus. Br J Anaesth 79:352–356PubMedCrossRef

Bartho L, Szolcsanyi J (1981) Opiate agonists inhibit neurogenic plasma extravasation the rat. Eur J Pharmacol 73:101–104PubMedCrossRef

Batra YK, Mahajan R, Bangalia SK, Nagi ON, Dhillon MS (2005) Bupivacaine/ketamine is superior to intra-articular ketamine analgesia following arthroscopic knee surgery. Can J Anaesth 52:832–836PubMedCrossRef

Beyzadeoglu T, Yilmaz C, Bekler H, Gokce A, Sayin MM (2007) Intraarticular tramadol plus pericapsular incisional bupivacaine provides better analgesia than intraarticular plus pericapsular incisional bupivacaine after outpatient arthroscopic partial meniscectomy. Knee Surg Sports Traumatol Arthrosc 15:564–568PubMedCrossRef

Boden BP, Fassler S, Cooper S, Marchetto PA, Moyer RA (1994) Analgesic effect of intraarticular morphine, bupivacaine, and morphine/bupivacaine after arthroscopic knee surgery. Arthroscopy 1:104–107

10.

Cook TM, Tuckey JP, Nolan JP (1997) Analgesia after day-case knee arthroscopy: double-blind study of intra-articular tenoxicam, intraarticular bupivacaine and placebo. Br J Anaesth 78:163–168PubMedCrossRef

11.

Denti M, Randelli P, Bigoni M et al (1997) Pre- and postoperative intraarticular analgesia for arthroscopic surgery of the knee and arthroscopy-assisted anterior cruciate ligament reconstruction: a double-blind randomized, prospective study. Knee Surg Sports Traumatol Arthrosc 5:206–212PubMedCrossRef

12.

Eroglu A, Saracoglu S, Erturk E, Kosucu M, Kerimoglu S (2010) A comparison of intraarticular morphine and bupivacaine for pain control and outpatient status after an arthroscopic knee surgery under a low dose of spinal anaesthesia. Knee Surg Sports Traumatol Arthrosc 18:1487–1495PubMedCrossRef

13.

Frank GB (1985) Stereospecific opioid drug receptors on excitable cell membranes. Can J Physiol Pharmacol 63:1023–1032PubMedCrossRef

14.

Gyires K, Budavari I, Furst S, Molnar I (1985) Morphine inhibits the carrageenan-induced oedema and the chemoluminescence of leucocytes stimulated by zymosan. J Pharm Pharmacol 37:100–104PubMedCrossRef

15.

Heard SO, Edwards WT, Ferrari D et al (1992) Analgesic effect of intraarticular bupivacaine or morphine after arthroscopic knee surgery: a randomized, prospective, double-blind study. Anesth Analg 6:822–826

16.

Jaffe JH, Martin WR (1990) Opioid analgesics and antagonists. In: Gilman AG, Rall TW, Nies AS, Taylor P (eds) The pharmacological basis of therapeutics, 8th edn. Pergamon Press, New York, pp 485–521

17.

Joshi GP, McCarroll SM, Cooney CM et al (1992) Intra-articular morphine for pain relief after knee arthroscopy. J Bone Joint Surg Br 74:749–751PubMed

18.

Kapral S, Gollmann G, Walt B et al (1999) Tramadol added to mepivacaine prolongs the duration of axillary plexus blockade. Anesth Analg 88:853–856PubMed

19.

Khoury GF, Chen AC, Garland DE, Stein C (1992) Intraarticular morphine, bupivacaine, and morphine/bupivacaine for pain control after knee videoarthroscopy. Anesthesiology 77:263–266PubMedCrossRef

20.

Kürflad H, Karsan O, Yüksek M, Atalay C, Uslu S (1998) The comparison of postoperative analgesic efficacy of intraarticular morphine and intraarticular tramadol. AGRI/J Turk Soc Algol 10:38–41

21.

Lawrence AJ, Joshi GP, Michalkiewicz A, Blunnie WP, Moriarty DC (1992) Evidence for analgesia mediated by peripheral opioid receptors in inflamed synovial tissue. Eur J Clin Pharmacol 43:351–355PubMedCrossRef

22.

Lembeck F, Donnerer J (1985) Opioid control of the function of primary afferent substance P fibres. Eur J Pharmacol 114:241–246PubMedCrossRef

23.

Likar R, Mathiaschitz K, Burtscher M, Stettner H (1995) Randomised, double- blind, comparitive study of morphine and tramadol administered intraarticularly for postoperative analgesia following arthroscopic surgery. Clin Drug Invest 10:17–21

24.

Marchal JM, Delgado-Martinez AD, Poncela M, Valanzuela J, de Dios Luna J (2003) Does the type of arthroscopic surgery modify the analgesic effect of intraarticular morphine and bupivacaine? A preliminary study. Clin J Pain 4:240–246CrossRef

25.

Raffa RB, Friderich E, Reimann W, Shank RP, Codd EE, Vaught JL (1992) Opioid and nonopioid components independently contribute to the mechanism of action of tramadol, an atypical opioid analgesic. J Pharmacol Exp Ther 260:275–285PubMed

26.

Raja SN, Dickstein RE, Johnson CA (1992) Comparison of postoperative analgesic effects of intraarticular bupivacaine and morphine following arthroscopic knee surgery. Anesthesiology 77:1143–1147PubMedCrossRef

27.

Senthilkumaran S, Tate R, Read JRM, Sutherland AG (2010) Intra-articular morphine and bupivicaine for post-operative analgesia in anterior cruciate ligament reconstruction: a prospective randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 18:731–735PubMedCrossRef

28.

Stein C, Comisel K, Haimerl E (1991) Analgesic effect of intraarticular morphine after arthroscopic knee surgery. N Engl J Med 325:1123–1126PubMedCrossRef

29.

Stein C, Millan MJ, Yassouridis A, Herz A (1998) Antinociceptive effects of mu- and kappa-agonists in inflammation are enhanced by a peripheral opioid receptor-specific mechanism. Eur J Pharmacol 155:255–264CrossRef

30.

Stein C, Pfluger M, Yassouridis A et al (1996) No tolerance to peripheral morphine analgesia in presence of opioid expression in inflamed synovia. J Clin Invest 98:793–799PubMedCrossRef

31.

Strichartz GR, Covino BG (1990) Local anesthetics. In: Miller RD (ed) Anestsia, 3rd edn. New York, Churchill Livingstone, pp 437–470

32.

Tran KM, Ganley TJ, Wells L, Ganesh A, Minger KI, Cucchiaro G (2005) Intraarticular bupivacaine-clonidine-morphine versus femoral-sciatic nerve block in pediatric patients undergoing anterior cruciate ligament reconstruction. Anesth Analg 101:1304–1310PubMedCrossRef

33.

Tuncer B, Babacan A, Arslan M (2007) Preemptive intraarticular tramadol for pain control after arthroscopic knee surgery. Agri 19:42–49PubMed

34.

Werz MA, Macdonald RL (1982) Heterogeneous sensitivity of cultured dorsal root ganglion neurones to opioid peptides selective for μ- and -opiate receptors. Nature 299:730–732PubMedCrossRef

35.

Wewers ME, Lowe NK (1990) A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 13:227–236PubMedCrossRef

36.

Wybran J (1985) Enkephalins and endorphins as modifiers of the immune system: present and future. Fed Proc 44:92–94PubMed

37.

Yaksh TL (1988) Substance P release from knee joint afferent terminals: modulation by opioids. Brain Res 458:319–324PubMedCrossRef

38.

Zeidan A, Kassem R, Nahleh N et al (2008) Intraarticular tramadol-bupivacaine combination prolongs the duration of postoperative analgesia after outpatient arthroscopic knee surgery. Anesth Analg 107:292–299PubMedCrossRef

Title: The comparison of intraarticular morphine–bupivacaine and tramadol–bupivacaine in postoperative analgesia after arthroscopic anterior cruciate ligament reconstruction
Authors: Habibollah Hosseini
Seyyed Mohammad Jalil Abrisham
Hossein Jomeh
Mohammad Kermani-Alghoraishi
Rahil Ghahramani
Mohammad Reza Mozayan
Publication date: 01-09-2012
Publisher: Springer-Verlag
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2012
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-011-1791-7

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

The comparison of intraarticular morphine–bupivacaine and tramadol–bupivacaine in postoperative analgesia after arthroscopic anterior cruciate ligament reconstruction

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 9/2012

Increased BMP expression in arthrofibrosis after TKA

Host serum is not indispensable in collagen performance in viable meniscal transplantation at 4-week incubation

Prosthetic inlay resurfacing for the treatment of focal, full thickness cartilage defects of the femoral condyle: a bridge between biologics and conventional arthroplasty

Restoration of the tibial ACL footprint area and geometry using the Modified Insertion Site Table

Effects of using a surgical clamp to hold tension while tying knots with commonly used orthopedic sutures

Minimally invasive Unicondylar Knee Arthroplasty in a patellectomized patient