Ss. Reuben et al., INTRAARTICULAR MORPHINE IN THE MULTIMODAL ANALGESIC MANAGEMENT OF POSTOPERATIVE PAIN AFTER AMBULATORY ANTERIOR CRUCIATE LIGAMENT REPAIR, Anesthesia and analgesia, 86(2), 1998, pp. 374-378
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.