Author/Editor		Vintar, Neli
Title		Zdravljenje bolečine s katetrom v kolenskem sklepu po artroskopski rekonstrukciji sprednje križne vezi: primerjava učinkovitosti mešanice ropivakaina, morfina in ketorolaka z mešanico ropovakain in morfina
Translated title		Intra-articular patient-controlled regional analgesia after arthroscopically assisted anterior cruicate ligament reconstruction: ropivacaine/morphine/ketorolac vs.ropivacaine/morphine
Type		monografija
Place		Ljubljana
Publisher		Univerza v Ljubljani, Medicinska fakulteta
Publication year		2005
Volume		str. 71
Language		slo, eng
Abstract		Background: Anterior cruciate ligament reconstruction (ACLR) has been increasingly performed as day surgery. It is associated with moderate to severe postoperative pain therefore a successful pain relief is essential to provide fast patient recovery and early mobilization. Intravenous morphine administration and epidural analgesia provide sufficient pain relief, but their side effects may prevent active physiotherapy. Aims: The clinical trial was designed to investigate the effectiveness of intraarticular patient-controlled regional analgesia (IAPCRA) in patients undergoing ACLR under spinal anesthesia. In the study the IA analgesic effect of ropivacaine and morphine combination with ketorolac was compared with the mixture of ropivacaine and morphine only. Consumption of rescue intravenous morphine at rest and during movement wascompared among groups. Methods: 39 patients, undergoing elective ACLR under spinal anesthesia, were enrolled in our prospective, randomized, double-blind study. At the end of the operation before closing the wounds, a multihole epidural catheter was placed intra-articularly and its position was arthroscopically confirmed. Patients were instructed to self-administer the analgesic mixture in the knee by using PCA pumps programmed to deliver 10 ml bolus with 60 min lockout interval. Patients were randomly classified into 3 groups of 13 patients. They received IA a 10 ml bolus: of 0.25% ropivacaine and 2 mg morphine in the RM group (n=13), in the RMK group (n=13) 0.25% ropivacaine, 2 mg morphine and 10 mg ketorolac, and in the placebo group (group P) (n=13) saline. If the patient still experienced severe pain (VAS>3) 15 min after IA bolus administration, 2 mg of rescue i.v. morphine could be self-administered by using intravenous PCA pumps with 10 min lockout intervals. Each patient also received 1g of paracetamol orally every 6 hours.
Descriptors		ANTERIOR CRUCIATE LIGAMENT ARTHROSCOPY PAIN, POSTOPERATIVE INJECTIONS, INTRA-ARTICULAR MORPHINE ANALGESIA, PATIENT-CONTROLLED BUPIVACAINE PAIN MEASUREMENT INDOMETHACIN ANESTHETICS, LOCAL ANTI-INFLAMMATORY AGENTS, NON-STEROIDAL PROSPECTIVE STUDIES DOUBLE-BLIND METHOD