Intraarticular Morphine Analgesia in Chronic Pain Patients with Osteoarthritis
Intraarticular Morphine Analgesia in Chronic Pain Patients with Osteoarthritis
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DOI：
10.1097/00000539-199706000-00025
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发表时间：
1997-06
影响因子：
5.7
通讯作者：
Rudolf Likar;M. Schafer;F. Paulak;Reinhard Sittl;W. Pipam;H. Schalk;D. Geissler;Günther Bernatzky
中科院分区：
文献类型：
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作者：
Rudolf Likar;M. Schafer;F. Paulak;Reinhard Sittl;W. Pipam;H. Schalk;D. Geissler;Günther Bernatzky
对照临床研究表明，局部给药吗啡可显著缓解术后急性疼痛。这种镇痛作用是持久的（长达48小时），是由外周阿片受体介导的。实验证据表明，随着疼痛性炎症过程的持续，外周阿片样物质的镇痛作用和外周感觉神经阿片样物质受体的密度增加。本研究观察了两组慢性疼痛骨性关节炎患者（n = 23）的膝关节注射1 mg吗啡的镇痛效果。采用随机双盲交叉设计，患者在第一阶段接受关节内注射吗啡和静脉注射生理盐水（a组，n = 13）或关节内注射生理盐水和静脉注射吗啡（B组，n = 10）。7天后，患者转入相反的治疗（II期）。在第一阶段，关节内注射吗啡比关节内注射生理盐水更能缓解疼痛，这种效果在休息和运动时都存在。镇痛作用令人惊讶地持久，并延伸到第二阶段，这是一种阻止第二阶段分析的结转效应。没有副作用的报道。通过外周作用阿片类药物治疗关节炎疼痛可能是目前可用的具有严重副作用的药物的一种有希望的替代方法。（Anesth Analg 1997;84:1313-7）
Controlled clinical studies have shown that local administration of morphine can significantly relieve acute postoperative pain.This analgesic effect is long-lasting (up to 48 h) and is mediated by peripheral opioid receptors. Experimental evidence shows that analgesic effects of peripheral opioids and the density of opioid receptors on peripheral sensory nerves increase with the duration of painful inflammatory processes. This study examines the analgesic effects of 1 mg of morphine injected into the arthritic knee joints of two groups of chronic pain patients (n = 23) suffering from osteoarthritis. Using a randomized, double-blind cross-over design, patients received either an intraarticular injection of morphine and intravenous saline (Group A, n = 13) or an intraarticular injection of saline and intravenous morphine (Group B, n = 10) during Phase I. Seven days later, patients crossed over to the opposite treatment (Phase II). During Phase I, intraarticular morphine resulted in significantly greater pain relief than intraarticular saline, and this effect was present at rest as well as during movement. The analgesic effect was surprisingly long-lasting and extended into Phase II, a carry-over effect that prevented the analysis of Phase II. No side effects were reported. The treatment of arthritic pain by peripherally acting opioids may be a promising alternative to currently available medications that have serious side effects. (Anesth Analg 1997;84:1313-7)