Porównanie trzech metod leczenia bólu po operacjach artroskopowych stawu ramiennego. Kliniczny efekt działania morfiny na obwodowe receptory ?

Leszek Zwolakiewicz¹, Roman Ostojski², Andrzej Basiński³

Summary
Background. There are no universal recommendations for an analgesic regimen after shoulder arthroscopic surgery. The most common method is on demand administration of NSAIDs or opioids. We have therefore compared, in a prospective, randomised, single-blinded study, the analgesic effects of intra-articular bupivacaine and intra-articular morphine to intramuscular ketoprofen. Special attention was paid to morphine binding to peripheral mju receptors, located in affected tissues. Methods. 51 patients (29 males and 22 females) aged 14-82 yrs, scheduled for arthroscopic shoulder surgery, were randomly divided into three group of 17 patients. Each group received either 20 ml of 0.5% bupivacaine, 5 mg morphine or placebo (normal saline), intra-articularly and on demand. Intramuscular ketoprofen was given if analgesia was inadequate. We noted the intensity of pain using the VAS scale at 6 hours after surgery, and the duration of analgesia, defined as the time between the first intra-articular injection and the first medication request. Results. The VAS was 8±1.7 in the control group, 5±1.6 in the bupivacaine group and 4.7±3.3 in the morphine group. Duration of analgesia was 72 ± 53 min, 351 ± 363 min and 721 ± 471 min, respectively. Discussion and conclusions. Intra-articular injections of bupivacaine or morphine were more effective than placebo and morphine was more effective than bupivacaine, probably due to its direct binding to the peripheral mju receptors.

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