Original Articles| Volume 17, ISSUE 5, P477-480, May 2001

Comparison of morphine and ropivacaine following knee arthroscopy


      Purpose: The purpose of this study was to compare the effectiveness of ropivacaine, a new local amidic anesthetic, compared with morphine as an intra-articular drug in controlling pain in patients after arthroscopic knee surgery. Type of Study: Randomized trial. Methods: We enrolled 90 patients scheduled to undergo elective knee arthroscopy. Patients were homogenous regarding demographic data and ASA physical status. Procedures included were diagnostic arthroscopies, lateral and medial meniscectomies, meniscal repair, and removal of loose bodies. All cases were treated by the same surgeon, under general anesthesia, using the same procedure. Patients were randomly divided into 3 groups. The first group received ropivacaine 75 mg in 20 mL of saline solution, the second group received 2 mg morphine in 20 mL of saline solution, and the third group received 20 mL of saline solution. No other oral or injectable analgesic administration was allowed. A blind observer assessed the patients’ postoperative pain using a 10-cm visual analogue scale (VAS), ranging from no pain (0) to unbearable pain (10). Scores were taken at 0, 1, 4, 6, 12, and 24 hours after drug injection. VAS scores were analyzed using analysis of variance; significance was set at P <.005. Results: None of the patients treated with ropivacaine or morphine needed administration of any other oral or injectable analgesic. No adverse reaction was noted in ropivacaine group. VAS score analysis in the first 4 postoperative hours showed greater effectiveness for ropivacaine versus morphine or placebo with highly significant results (P <.001). In the first 24 postoperative hours, the ropivacaine group versus the morphine group showed no significant differences (P =.207). Conclusions: Although its cost is very high compared with morphine, ropivacaine is a safe, site-specific, and long lasting anesthetic drug with an earlier onset than morphine and almost the same duration, covering the whole postoperative period (24 hours).
      Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 5 (May-June), 2001: pp 477–480


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        • Stein C
        • Millan MJ
        • Shippenberg TS
        • Peter K
        • Herz A
        Peripheral opioid receptors mediating antinociception inflammation: Evidence for involvement of mu, delta and kappa receptors.
        J Pharmacol Exp Ther. 1989; 248: 1269-1275
        • Stein C
        • Comisel K
        • Haimerl E
        • Yassouridis A
        • Lehberger K
        • Herz A
        • Peter K
        Analgesic effects of intraarticular morphine after arthroscopic knee surgery.
        N Engl J Med. 1991; 325: 1123-1126
        • Allen GC
        • Amand MA
        • Lui ACP
        • Johnson DH
        • Lindsay MP
        Postarthroscopy analgesia with intraarticular bupivacaine/morphine. A randomized clinical trial.
        Anesthesiology. 1993; 79: 475-480
        • Chirwa SS
        • MacLeod BA
        • Day B
        Intraarticular bupivacaine (Marcaine) after arthroscopic meniscectomy: A randomized double-blind controlled study.
        Arthroscopy. 1989; 5: 33-35
        • Joshi GP
        • McCarroll SM
        • Cooney CM
        • Blunnie WP
        • O’Brien TM
        • Lawrence AJ
        Intra-articular morphine for pain relief after knee arthroscopy.
        J Bone Joint Surg Br. 1992; 74: 749-751
        • Raja SN
        • Dickstein RE
        • Johnson CA
        Comparison of postoperative analgesic effects of intraarticular bupivacaine and morphine following arthroscopic knee surgery.
        Anesthesiology. 1992; 77: 1143-1147
        • Aasbo V
        • Raeder JC
        • Grogaard B
        • Roise O
        No additional analgesic effect of intra-articular morphine or bupivacaine compared with placebo after elective knee arthroscopy.
        Acta Anaesthesiol Scand. 1996; 40: 585-588
        • Capeda MS
        • Uribe C
        • Betancourt J
        • Rugeles J
        • Carr DB
        Pain relief after knee arthroscopy: Intra-articular morphine, intra-articular bupivacaine, or subcutaneous morphine?.
        Reg Anesth. 1997; 22: 233-238
        • Lundin O
        • Rydgren B
        • Sward L
        • Karlsson J
        Analgesic effects of intraarticular morphine during and after knee arthroscopy: A comparison of two methods.
        Arthroscopy. 1998; 14: 192-196
        • De Andres J
        • Valla JC
        • Barrera L
        • Colomina R
        Intra-articular analgesia after arthroscopic knee surgery: Comparison of three different regimens.
        Eur J Anaesthesiol. 1998; 15: 10-15
        • Gurkan Y
        • Kilickan L
        • Buluc L
        • Muezzinoglu S
        • Toker K
        Effects of diclofenac and intra-articular morphine/bupivacaine on postarthroscopic pain control.
        Minerva Anestesiol. 1999; 65: 741-745
        • Stein C
        • Gramsch C
        • Herz A
        Intrinsic mechanisms of antinociception in inflammation: Local opioid receptors and beta-endorphin.
        J Neurosci. 1990; 10: 1292-1298
        • Wolff AP
        • Hasselstrom L
        • Kerkkamp HE
        • Gielen MJ
        Extradural ropivacaine and bupivacaine in hip surgery.
        Br J Anaesth. 1995; 74: 458-460
        • Scott DB
        • Lee A
        • Fagan D
        • Bowler GMR
        • Bloomfield P
        • Lundh R
        Acute toxicity of ropivacaine compared with that of bupivacaine.
        Anesth Analg. 1989; 69: 563-569
        • Kaeding CC
        • Hill JA
        • Katz J
        • Benson L
        Bupivacaine use after knee arthroscopy: Pharmacokinetics and pain control study.
        Arthroscopy. 1990; 6: 33-39
        • Katz JA
        • Kaeding CS
        • Hill JR
        • Henthorn TK
        The pharmacokinetics of bupivacaine when injected intra-articularly after knee arthroscopy.
        Anesth Analg. 1988; 67: 872-875
        • Knudsen K
        • Beckman SM
        • Blomberg S
        • Sjovall J
        • Edvardsson N
        Central nervous and cardiovascular effects of i.v. infusion of ropivacaine, bupivacaine and placebo in volunteers.
        Br J Anaesth. 1997; 78: 507-514