Comparison of the analgesic effect of intra-articular and extra-articular injection of morphine and ketamine compound in arthrotomy lower limb surgery under spinal anesthesia.

Reza Akhondzadeh

doi:10.12669/pjms.305.4775

Abstract

Objective: One of the critical components in the postoperative care is pain. Given that little research has been done regarding the analgesic effects of intra-articular injection of ketamine, this study was aimed to compare the analgesic effect of intra-articular and extra-articular injection of morphine and ketamine compound in arthrotomy surgery under spinal anesthesia. Methods: A total of 50 patients were candidate for arthrotomy surgery, aged 18-60 years were divided randomly into two groups. At the end of surgery, the first group was treated with combination of intra-articular morphine and ketamine compound and the second group was treated with combination of extra-articular morphine and ketamine compound. The amount of postoperative pain was recorded in the hours of 2,4,6,12,24 respectively. Also 24 hours consumption of rescue analgesic was recorded. Results: The pain severity (VAS) in the hours of 2, 4, 6, 12 and 24 after surgery in the intra-articular injection group was significantly lower than the extra-articular injection group (P<0.05). Postoperative morphine consumption in intra-articular injection group (3.2±3.78) was significantly less than the extra-articular injection group (6.36±5.22) (p = 0.018). Conclusion: Postoperative pain severity of intra-articular injection of ketamine and morphine in knee surgery is less than extra-articular injection.

Highlights

One of the critical components in the postoperative care of patients is acute post-operative pain control
The first group was treated with a combination of morphine and ketamine compound by intraarticular injection and the second group was treated with the same compound extra-articularly
The mean first time of receiving morphine in post-operative intraarticular injection was 192±169.2 minutes and in the extra-articular group was 235.2±171 minutes and no statistical significant difference was observed between the two groups (P=0.45).The average pain severity (VAS) at 2, 4, 6, 12 and 24 hours after surgery in intra-articular injection group was significantly lower than the extra-articular injection (P

Summary

Introduction

One of the critical components in the postoperative care of patients is acute post-operative pain control. After discovering the path of pain in the 19th century, significant improvements have been achieved in the field of pain management.[1] The role of the anesthesiologist is key and important in this respect. Improper control of postoperative acute pain causes fatal complications of hemodynamic instability and increase the duration of hospitalization and cost of treatment.[2,3] Due to the plethora of artrotomy surgery and severe pain in the postoperative stage, adequate pain control is necessary to accelerate the recovery movement of patient.[4,5,6,7] Such methods include continuous epidural analgesia, femoral nerve block, Patient controlled analgesia (PCA) and intra-articular injection of local anesthetics or opioid drugs.[8,9,10,11]

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Results

Conclusion