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Effects of morphine on peri-articular infiltration analgesia in total knee arthroplasty: a prospective, double-blind, randomized controlled trial

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Abstract

Purpose

Peri-articular infiltration analgesia (PIA) is a widely used method to control post-operative pain in total knee arthroplasty (TKA) patients. However, there are limited data that support the use of morphine in PIA. This study aims to evaluate the efficacy of peri-articular morphine infiltration for pain management in TKA patients.

Methods

Based on a double-blind, randomized approach, patients were allocated to the morphine or control group. Patients in the morphine group received a peri-articular infiltration of an analgesic cocktail consisting of ropivacaine, epinephrine, and morphine. Morphine was omitted from the cocktail in the control group. Primary outcomes were post-operative consumption of morphine hydrochloride used for rescue analgesia and post-operative pain as assessed by visual analog scale (VAS) score. Secondary outcomes were functional recovery as assessed by a range of knee motion, quadriceps strength, and daily ambulation distance. The duration of hospital stay was also recorded. Tertiary outcomes included the occurrence of post-operative adverse effects and the consumption of antiemetics.

Results

Patients in the morphine group had significantly lower post-operative morphine consumption in the first 24 h and total morphine consumption. There was no significant difference between the two groups in post-operative VAS pain scores at rest or during motion. There was no significant difference between the two groups in the post-operative knee range of motion, quadriceps strength, daily ambulation distance, or duration of post-operative hospital stay. The two groups were similar in the incidence of adverse effects and the consumption of antiemetics.

Conclusion

Adding morphine into the analgesic cocktail of PIA could reduce postoperative morphine consumption in TKA patients, but does not improve early pain relief or accelerate functional recovery or provide clinical benefits for TKA patients. In addition, the complications and safety of peri-articular morphine infiltration need to be further investigated in larger sample studies.

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Acknowledgments

This study was supported by the 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University. We want to express our sincere appreciation for all the patients that joined this study.

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Author notes

  1. Qiuru Wang and Jikui Sun contributed equally to this work and should be regarded as first co-authors.

Authors and Affiliations

  1. Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, People’s Republic of China

    Qiuru Wang & Pengde Kang

  2. State Key Laboratory of Oral Diseases, West China School Stomatology, Sichuan University, No. 14, Third Section South Renmin Road, Chengdu, 610041, People’s Republic of China

    Jikui Sun

  3. Department of General Surgery, Yongchuan Hospital of Traditional Chinese Medicine, 2# Yingbin Road, Yongchuan, Chongqing, 402160, People’s Republic of China

    Yunlian Hu

  4. Department of Anesthesiology, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, People’s Republic of China

    Yan Zeng, Jian Hu & Jing Yang

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  1. Qiuru Wang
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Corresponding authors

Correspondence to Jing Yang or Pengde Kang.

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The authors declare that they have no conflict of interest.

Ethical review committee statement

This study was approved by the Clinical Trials and Biomedical Ethics Committee of West China Hospital, and written informed consents were obtained from all participants. The study had IRB approval, the clinical trial registration number was ChiCTR2000028919.

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Jing Yang and Pengde Kang contributed equally to this work and should be regarded as co-corresponding authors.

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Wang, Q., Sun, J., Hu, Y. et al. Effects of morphine on peri-articular infiltration analgesia in total knee arthroplasty: a prospective, double-blind, randomized controlled trial. International Orthopaedics (SICOT) 44, 2587–2595 (2020). https://doi.org/10.1007/s00264-020-04700-z

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