Comparison of efficacy of intra-articular morphine and steroid in patients with knee osteoarthritis.
Comparison of efficacy of intra-articular morphine and steroid in patients with knee osteoarthritis.
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DOI：
10.4103/0970-9185.101940
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发表时间：
2012-10
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影响因子：
--
通讯作者：
Beyaz SG
中科院分区：
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作者：
Beyaz SG
治疗膝关节骨关节炎的主要目的是减轻骨关节炎的疼痛。本研究的目的是比较关节内注射曲安西龙与关节内注射吗啡在缓解老年人膝关节骨关节炎疼痛方面的疗效。年龄在50 - 80岁之间的患者被随机分为三组。M组关节内注射吗啡+布比卡因，T组关节内注射曲安奈德+布比卡因，C组关节内注射生理盐水+布比卡因。在注射前和注射后第2、4、6和12周对患者进行评估。一线补充镇痛药为口服对乙酰氨基酚1500 mg/天。如果对乙酰氨基酚的镇痛作用不充分，建议患者口服右酮洛芬氨丁三醇50 mg/天。关节内注射后，与C组相比，M组和T组的视觉模拟量表（VAS）评分在统计学上显著降低。前2周观察到的VAS评分下降持续稳定至第12周末。与C组相比，M组和T组的WOMAC评分显著降低。吗啡组和类固醇组的WOMAC评分无显著差异。吗啡组和类固醇组使用的辅助镇痛剂明显较少。关节内注射吗啡与关节内注射曲安西龙对膝骨关节炎患者的镇痛效果相同。关节内注射吗啡可能比关节内注射类固醇更好，因为它的副作用更小。
Primary therapeutic aim in treatment of osteoarthritis of the knee is to relieve the pain of osteoarthritis. The aim of this study was to compare the efficacy of intra-articular triamcinolone with intra-articular morphine in pain relief due to osteoarthritis of the knee in the elderly population. Patients between 50 and 80 years of age were randomized into three groups. Group M received morphine plus bupivacaine intra-articularly, Group T received triamcinolone plus bupivacaine intra-articularly, and Group C received saline plus bupivacaine intra-articularly. Patients were evaluated before injection and in 2nd, 4th, 6th, and 12th weeks after injection. First-line supplementary analgesic was oral paracetamol 1500 mg/day. If analgesia was insufficient with paracetamol, oral dexketoprofen trometamol 50 mg/day was recommended to patients. After the intra-articular injection, there was statistically significant decrease in visual analog scale (VAS) scores in Groups M and T, when compared to Group C. The decrease of VAS scores seen at the first 2 weeks continued steadily up to the end of 12th week. There was a significant decrease in Groups M and T in the WOMAC scores, when compared to Group C. There was no significant difference in the WOMAC scores between morphine and steroid groups. Significantly less supplementary analgesics was used in the morphine and steroid groups. Intra-articular morphine was as effective as intra-articular triamcinolone for analgesia in patients with osteoarthritis knee. Intra-articular morphine is possibly a better option than intra-articular steroid as it has lesser side effects.