小剂量吗啡关节腔内注射用于膝关节镜术后镇痛的临床研究

Low-dose intra-articular morphine injection for postoperative analgesia following knee arthroscopy

目的观察小剂量吗啡关节腔内注射应用于膝关节镜术后镇痛的效果。方法采用随机、双盲研究。选择蛛网膜下隙麻醉下行膝关节镜手术的患者60例,随机均分为吗啡组和对照组。吗啡组术后在关节腔内注射盐酸吗啡2 mg,对照组注射等体积0.9%氯化钠溶液。记录给药后2、4、8、16、24、48和72 h时在膝关节被动伸直和屈曲90°状态下的疼痛视觉模拟评分(VAS评分)及不良反应。结果术后4、8、16、24、48和72 h,吗啡组在膝关节被动伸直及屈曲90°状态下的疼痛VAS评分均显著低于对照组(P值均<0.05)。两组均未发生严重不良反应。结论小剂量吗啡关节腔内注射可以有效缓解膝关节镜术后的疼痛。

Objective To evaluate the effects of low dose intra-articular morphine injection for postoperative analgesia after knee arthroscopy. Methods Sixty postoperative patients undergoing elective knee arthroscopy were randomized into two equal groups for intra-articular morphine injection at 2 nag solved in 5 ml saline solution（group A） or for injection with the same volume of normal saline（group B）, At 2, 4, 8, 16, 24, 48 and 72 h after the injections, the visual analogue scale（VAS） was measured for passive knee extension and 90-degree flexion, and the adverse effect in association with the injections were recorded. Results In group A, the VAS scores for passive knee extension at 4, 8, 16, 24, 48 and 72 h after the injection were significantly lower than those in group B （P〈0.05） , The scores for knee flexion in group A at these time points were also significantly lower than those in group B （P 〈 0.05） , The VAS scores at 2 h after injection were similar between the two groups. No serious adverse effects except for itching（in 1 case in each group） were observed in the two groups. Conclusion Low-dose intra-articular morphine injection can effectively relieve the pain after arthroscopic knee surgery, （Shanghai Med J, 2007, 30：905-906）