INTRAARTICULAR MORPHINE IN THE MULTIMODAL ANALGESIC MANAGEMENT OF POSTOPERATIVE PAIN AFTER AMBULATORY ANTERIOR CRUCIATE LIGAMENT REPAIR

Reconstruction oi the anterior cruciate ligament (ACL) is associated w ith a considerable degree of postoperative pain. Our customary multimo dal approach to postoperative analgesia after ambulatory ACL surgery i ncludes perioperative nonsteroidal antiinflammatory drugs, pre-and pos tincisional intraarticular (IA) bupivacaine (B), and postoperative cry otherapy using an external cooling system. This study was designed to determine whether the addition of IA morphine (MS) provides improved p ostoperative analgesia, One hundred patients schedule for elective amb ulatory ACL repair received our standard multimodal therapy. After sur gery, patients were randomized to one or four study groups. Group 1 re ceived 30 mL of 0.25% B IA. Group 2 received 30 mL of normal saline IA and 5 mg of MS IA. Group 3 received 30 mL of 0.25% bupivacaine IA and 5 mg of MS IV. Group 4 received 30 mL of 0.25% B IA and 5 mg of MS IA . The addition of IA B postoperatively provided prolonged. analgesia a nd decreased postoperative pain and analgesic requirements. The additi on of MS to IA B did not provide additional postoperative analgesia. W e conclude that patients undergoing ambulatory ACL repair using our st andard multimodal analgesic regimen failed to receive additional posto perative analgesia when MS was added to the IA B. Implications: Patien ts receiving a multimodal analgesic regimen of perioperative nonsteroi dal antiinflammatory drugs, intraarticular bupivacaine, and external c ooling did not receive any additional analgesia from intraarticular mo rphine.