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Submitted: 16 May 2007 Modified: 26 April 2016
HERDIN Record #: PCHRDPC051106

Postoperative analgesic effects of a placebo controlled trial of intraarticular morphine sulfate and intraarticular pethidine HCI for patients undergoing anterior cruciate ligament reconstruction using bone patellar graft.

1Alet Gerardo C. Hernandez,
2Jonathan  G. Dela Cruz,
3Jonnel L. Lim
Department of Anesthesiology - St. Luke's Medical Center


Background: Postoperative pain is considered the main cause of morbidity after anterior cruciate ligament (ACL) repair Objectives: This study was designed to determine whether a placebo controlled trial of intraarticular (IA) Morphine sulfate and IA Pethidine HCI would provide postoperative pain relief for patients undergoing ACL reconstruction utilizing bone patellar graft Methods: A randomized, double blind, placebo controlled trial of 60 patients, 18-65 years, ASA I and II scheduled for ACL reconstruction were included in the study. Group I received IA Morphine sulfate 3mg (0.015 percent) solution, Group II received IA Pethidine HCI 30mg (0.15 percent) solution and Group III received IA saline 20 cc solution alone. VAS scores were obtained during the 1st, 2nd, 6th and 24th hour after surgery. Analgesic duration, rescue medication consumption, and occurrence of complications were determined Results: VAS score comparisons were analyzed using Kruskal-Wallis Test and Wilcoxons Matched Pairs Signed Rank test which revealed significant differences among all groups. Analgesic duration and 24-hr rescue medication consumption were also analyzed and results also demonstrated significant differences. However, occurrence of complications was not observed in all clinical trial groups Conclusion: We conclude that IA morphine and IA Pethidine HCI have analgesic effects. IA Pethidine HCI has less analgesic effects as compared to IA morphine sulfate. IA morphine sulfate has the longest analgesic duration and lastly, that IA Morphine sulfate and IA Pethidine HCI offer a well tolerated postoperative pain control with no evidence of complications. (Author)

Publication Type:
Publication Sub Type:
Journal Article, Original
Philippine Journal of Anesthesiology
Publication Date:
July-December 2004
The Philippine Society of Anesthesiologists, Inc.


This study was designed to determine whether intraarticular (IA) Morphine Sulfate, IA Pethidine HCI, placebo would provide postoperative pain relief for patients undergoing ACL reconstruction utilizing bone patellar graft. Specific objective of the study were to: (1) Determine if IA Pethidine HCI has the same analgesic effect with IA Morphine sulfate thru visual analog scale (VAS) comparison, (2) Determine analgesic duration for all groups, (3) Compare rescue medication by documenting IV/ Oral NSAID and IV opioid consumption, and (4) Determine occurrence of postoperative complication like nausea, vomiting, pruritus and respiratory depression.

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Philippine Council for Health Research and Development Library Box No. 115 Fulltext pdf (Request Document)
1. Rosier, RN . Orthopaedics. Principles of Surgery New York: McGraw - Hill, Inc., 1994. 1924. (6th ed)
2. Scott, WN . Arthroscopic anterior cruciate ligament reconstruction utilizing tendon in Cannon WD (ed). The Knee St. Louis Missouri: Mosby - Year Book Inc., 1994. 757.
3. Reuben, SS , et. al., . "Intraarticular morphine in the multimodal analgesic management of postoperative pain after ambulatory anterior cruciate ligament repai" Anesth Analg 86(2): 374-378, 1998 - [External Link]
4. Joris, JL , Dubner, R , Hargreaves, KM . "Opioid analgesia at peripheral sites: a target for opioids released during stress and inflammation?" Anesth Analg 66(12): 1277-1281, 1987 - [External Link]
5. Stein, C , et. al., . "Opioids from immunocytes interact with receptors on sensory nerves to inhibit nociception in inflammation" Proc Natl Acad Sci U S A 87(15): 5935-5939, 1990 - [External Link]
6. Maekawa, K , et. al., . "In situ hybridization study of mu- and kappa-opioid receptor mRNAs in the rat spinal cord and dorsal root gangli" Neuroscience Letters 168(1-2): 97-100, 1994 - [External Link]
7. Likar, R , et. al., . "Intraarticular morphine analgesia in chronic pain patients with osteoarthritis" Anesth Analg 84(6): 1313-1317, 1997 - [External Link]
8. Stein, C , et. al., . "Analgesic Effect of Intraarticular Morphine after Arthroscopic Knee Surgery" N Engl J Med 325, 1123-1126, 1991 - [External Link]
9. Lawrence, AJ , et. al., . "Evidence for analgesia mediated by peripheral opioid receptors in inflamed synovial tissue" Eur J Clin Pharmac 43(4): 351-355, 1992 - [External Link]
10. Joshi, GP , et. al., . "Intra-articular morphine for pain relief after anterior cruciate ligament repair" Br J Anaesth 70(1): 87-88, 1993 - [External Link]
11. Gentili, M , et. al., . "Intra-articular morphine and clonidine produce comparable analgesia but the combination is not more effective" Br J Anaesth 79(5): 660-661, 1997 - [External Link]
12. Tverskoy, M , et. al., . "The peripheral effect of fentanyl on postoperative pain" Anesth Analg 87(5): 1121-1124, 1998 - [External Link]
13. Vranken, JH , et. al., . "Intraarticular sufentanil administration facilitates recovery after day-case knee arthroscopy" Anesth Analg 92(3): 625-628, 2001 - [External Link]
14. Reuben, SS , Sklar, J , El-Mansouri, M . "The preemptive analgesic effect of intraarticular bupivacaine and morphine after ambulatory arthroscopic knee surgery" Anesth Analg 92(4): 923-926, 2001 - [External Link]
15. Stein, C . "Peripheral Mechanisms of Opioid Analgesia" anesthesia analgesia 76(1): 1993, 1993 - [External Link]
16. Stein, C , Yassouridis, A . "Peripheral morphine analgesia" Pain 71(2): 119-121, 1997 - [External Link]
17. Stein, C , et. al., . "Peripheral opioid receptors mediating antinociception in inflammation. Evidence for involvement of mu, delta and kappa receptors" J Pharmacol Exp Ther 248(3): 1269-1275, 1989 - [External Link]
18. Denti, M , et. al., . "Pre- and postoperative intra-articular analgesia for arthroscopic surgery of the knee and arthroscopy-assisted anterior cruciate ligament reconstruction. A double-blind randomized, prospective study" Knee Surg Sports Traumatol Arthrosc 5(4): 206-212, 1997 - [External Link]
19. Lyons, B , et. al., . "Modification of pain on injection of propofol. A comparison of pethidine and lignocaine" Anaesthesia 51(4): 394-395, 1996 - [External Link]
20. Barash, PG , Cullen, BF , Stoelting, R . Handbook of Clinical Anesthesia Philadelphia: Lippincott Williams & Wilkins, 2001. 161. (4th ed.)
21. Kligman, M , et. al., . "Intra-synovial, compared to intra-articular morphine provides better pain relief following knee arthroscopy menisectomy" Can J Anaesth 49(4): 380-383, 2002 - [External Link]
22. Ezekiel, MR . Current Clinical Strategies: Handbook of Anesthesiology Singapore: SSC Publishing, 1995. 24. (1st ed.)
23. Stanski, DR , et. al., . "Kinetics of intravenous and intramuscular morphine" Clin Pharmacol Ther 24(1): 52-59, 1978 - [External Link]