Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942005000500003
Brazilian Journal of Anesthesiology
Scientific Article

Estudo comparativo da analgesia entre bupivacaína e morfina intra-articular em osteoartrite de joelho

Intra-articular bupivacaine and morphine for knee osteoarthritis analgesia. Comparative study

Miriam C B Gazi; Adriana Machado Issy; Rioko Kimiko Sakata

http://dx.doi.org/10.1590/S0034-70942005000500003 Braz J Anesthesiol, vol.55, n5, p.491-499, 2005
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Resumo

JUSTIFICATIVA E OBJETIVOS: A osteoartrite é a mais freqüente entre as doenças articulares em pessoas idosas. O objetivo do estudo foi comparar o efeito analgésico da bupivacaína e da morfina por via intra-articular em pacientes portadores de osteoartrite de joelho. MÉTODO: Foram avaliados 39 pacientes em estudo duplamente encoberto, divididos de forma aleatória, em dois grupos: os do G1 (n = 18) receberam 1 mg (1 mL) de morfina diluída em 9 mL de solução fisiológica a 0,9% e os do G2 (n = 21), 25 mg (10 mL) de bupivacaína a 0,25% sem vasoconstritor, por via intra-articular. A intensidade da dor foi avaliada pela escala numérica e verbal nos momentos 0, 30, 60 minutos e 7 dias, em repouso e em movimento. Foram avaliados a necessidade de complementação analgésica com paracetamol (500 mg), a dose total de analgésico utilizado, a duração da analgesia e a qualidade da analgesia (pelo paciente). RESULTADOS: Dos 39 pacientes, 31 completaram o estudo. Não houve diferença significativa da intensidade da dor em repouso e em movimento entre os dois grupos nos momentos estudados. Não houve diferença entre os dois grupos no tempo entre a administração da solução e a necessidade de complementação analgésica. A dose média do paracetamol utilizada no primeiro dia da semana foi de 796 mg do G1 e de 950 mg no G2; a complementação na semana foi de 3578 mg no G1 e 5333 mg no G2. CONCLUSÕES: O efeito analgésico de 1 mg de morfina e de 25 mg de bupivacaína a 0,25% sem vasoconstritor intra-articular foram semelhantes.

Palavras-chave

ANALGESIA, ANALGÉSICOS, ANALGÉSICOS, ANESTÉSICOS, ANESTÉSICOS, DOR, DOR

Abstract

BACKGROUND AND OBJECTIVES: Osteoarthritis is the most common joint disease among elderly people. This study aimed at comparing the analgesic effects of intra-articular bupivacaine and morphine in knee osteoarthritis patients. METHODS: Thirty-nine patients were included in this randomized double-blind study and divided in two groups: G1 (n = 18) patients were given intra-articular 1 mg (1 mL) morphine diluted in 9 mL of 0.9% saline, while G2 (n = 21) received intra-articular 25 mg (10 mL) of 0.25% plain bupivacaine. Pain intensity was evaluated by numerical and verbal scale at 0, 30, 60 minutes and 7 days at rest and in movement. Evaluated parameters were analgesic supplementation requirement with paracetamol (500 mg), total analgesic dose throughout the study, analgesia duration and quality (according to patient). RESULTS: From 39 patients, 31 have completed the study. There has been no significant difference in pain intensity at rest and in movement between groups in all studied moments. There has been no difference between groups in time between solution administration and need for analgesic supplementation. Mean paracetamol dose in the first day was 796 mg for G1 and 950 mg for G2; supplementation during the week was 3578 mg for G1 and 5333 mg for G2. CONCLUSIONS: The analgesic effect of intra-articular 1 mg morphine and 25 mg of 0.25% plain bupivacaine was similar.

Keywords

ANALGESIA, ANALGESICS, ANALGESICS, ANESTHETICS, ANESTHETICS, PAIN, PAIN

References

McCarthy C, Cushnaghan J, Osteoarthritis Dieppe P. Textbook of Pain. 1994:387-396.

Felson DT, Zhang Y, Hannan MT. The incidence and natural history of knee osteoarthritis in the elderly: The Framingham Osteoarthritis Study. Arthritis Rheum. 1995;38:1500-1505.

Peloso PM. Opioid therapy for osteoarthritis of the hip and knee: use it or lose it?. J Rheumatol. 2001;28:6-11.

Gilliland BC. Arthritis and Periarthritic Disorders. The Management of Pain. 1990:329-351.

Felson DT. Weight and osteoarthritis. J Rheumatol Suppl. 1995;43:7-9.

Sowers M. Epidemiology of risk factors for osteoarthritis: systemic factors. Curr Opin Rheumatol. 2001;13:447-451.

Chan ST. Intra-articular morphine and bupivacaine for pain relief after therapeutic arthroscopic knee surgery. Singapore Med J. 1995;36:35-37.

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

Keates HL, Cramond T, Smith MT. Intraarticular and periarticular opioid binding in inflamed tissue in experimental canine arthritis. Anesth Analg. 1999;89:409-415.

Ritter MA, Koehler M, Keating EM. Intra-articular morphine and/or bupivacaine after total knee replacement. J Bone Joint Surg Br. 1999;81:301-303.

Creamer P, Hunt M, Dieppe P. Pain mechanisms in osteoarthritis of the knee: effect of intraarticular anesthetic. J Rheumatol. 1996;23:1031-1036.

Moote CA. The prevention of postoperative pain. Can J Anaesth. 1994;41:527-533.

Likar R, Schafer M, Paulak F. Intraarticular morphine analgesia in chronic pain patients with osteoarthritis. Anesth Analg. 1997;84:1313-1317.

Stein A, Yassouridis A, Szopko C. Intraarticular morphine versus dexamethasone in chronic arthritis. Pain. 1999;83:525-532.

Khoury GF, Garland DE, Stein C. Intraarticular opioid-local anesthetic combinations for chronic joint pain. Middle East J Anesthesiol. 1994;12:579-585.

Reuben SS, Connelly NR. Postoperative analgesia for outpatient arthroscopic knee sugery with intraarticular bupivacaine and ketorolac. Anesth Analg. 1995;80:1154-1157.

Reuben SS, Sklar J, El-Mansouri M. The preemptive analgesic effect of intraarticular bupivacaine and morphine after ambulatory arthroscopic knee surgery. Anesth Analg. 2001;92:923-926.

Dalsgaard J, Felsby S, Juelsgaard P. Low-dose intra-articular morphine analgesia in day case knee arthroscopy: a randomized double-blinded prospective study. Pain. 1994;56:151-154.

Reuben SS, Connelly NR. Postarthroscopic meniscus repair analgesia with intraarticular ketorolac or morphine. Anesth Analg. 1996;82:1036-1039.

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