Abstract
Purpose
To compare the analgesia produced by comparable doses of intra-articular (IA) morphine and fentanyl.
Methods
Sixty-nine healthy patients undergoing arthroscopic surgery received a standardized general anesthetic of 4 mg· kg−1 thiopental and 2 μg· kg−1 fentanyl followed by 2 mg· kg−1 succinylcholine prior to tracheal intubation and controlled ventilation. Maintenance of anesthesia was achieved with N2O/O2 and isoflurane. At the conclusion of surgery intra-articular injection was: Group I (n=23) 50 μg fentanyl in 20 ml saline; Group II (n = 24) 3 mg morphine in 20 ml saline; Group III (n=22) 20 ml saline. Pain scores at rest using a visual analogue scale were recorded by a separate blinded observer at one, two, four, and eight hours postoperatively.
Results
Pain scores at one, two, four, and eight hours were 36, 26.3, 20.9, and 12.8vs 35.8, 33.8, 28.8, and 21.9 vs 70.5, 57.7, 58.4, and 53.6 for the IA-fentanyl, IA-morphine, and control groups respectively. Pain scores were greater at all times for Group III. Pain scores for Groups I and II were similar at one hour, but thereafter were less (P < 0.001) for the IA-fentanyl group.
Conclusion
Better postoperative analgesia was achieved with 50 μg intraarticular fentanyl than with 3 mg intraarticular morphine.
Objectif
Comparer l’analgésie produite par des doses comparables de morphine et de fentanyl intra-articulaires (IA).
Méthode
Soixante-neuf patients en santé devant subir une intervention arthroscopique ont reçu une anesthésie générale standard avec 4 mg· kg−1 de thiopental et 2 μg· kg−1 de fentanyl suivis de 2 mg· kg−1 de succinylcholine avant l’intubation endotrachéale et la ventilation contrôlée. On a maintenu l’anesthésie avec N2O/O2 et de l’isoflurane. À la fin de l’opération, l’injection intra-articulaire comprenait: Groupe I (n=23), 50 μg de fentanyl dans 20 ml de solution salée; Groupe II (n=24) 3 mg de morphine dans 20 ml de solution salée; Groupe III (n=22) 20 ml de solution salée. Les scores de douleur ont été notés au repos au moyen d’une échelle visuelle analogue par un observateur impartial distinct à une, deux, quatre et huit heures après l’opération.
Résultats
Les scores ont été à une, deux, quatre et huit heures de 36-26,3-20,9-12,8vs 35,8-33,8-28,8-21,9 vs 70,5-57,7-58,4-53,6 pour les patients qui ont reçu du fentanyl IA, de la morphine IA et la solution salée, respectivement. Les scores de douleur ont été plus grands, en tout temps, chez les patients du Groupe III. Les scores de douleur ont été similaires chez les patients des Groupes I et II à une heure, mais moindres par la suite (P < 0,001) pour les patients qui ont reçu du fentanyl IA.
Conclusion
Une analgésie plus efficace a été obtenue avec l’injection intra-articulaire de 50 μg de fentanyl plutôt que 3 mg de morphine.
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Varkel, V., Volpin, G., Ben-David, B. et al. Intraarticular fentanyl compared with morphine for pain relief following arthroscopic knee surgery. Can J Anesth 46, 867–871 (1999). https://doi.org/10.1007/BF03012977
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DOI: https://doi.org/10.1007/BF03012977