Reduced morphine consumption and pain severity with transdermal fentanyl patches following total knee arthroplasty.

PURPOSE: To determine the effects of transdermal fentanyl patches (TFPs) for postoperative analgesia in patients undergoing total knee arthroplasty (TKA) surgery. METHODS: A randomized, double-blind, controlled trial study of 40 ASA I-III patients undergoing TKA surgery was performed under general anaesthesia. Patients were randomly divided into two groups. Group I (n = 20) received two 25 µg TFPs placed on the laterals of chest wall approximately 12 h before induction of general anaesthesia. Group II, the control group (n = 20), received placebo patches of identical size. Postoperative pain at rest was assessed with visual analogue scale (VAS) at 0, 30 min and 2, 4, 6, 12, 24, 48 and 72 h. Total rescue consumption of morphine was estimated with patient control analgesia during the first 72 h after operation. The degree of active knee flexion and incidence of side effects were also evaluated. RESULTS: The VAS scores at 2, 4, 6, 12, 24, 48 and 72 h were significantly less in the group I compared to the group II (p < 0.05). Total morphine consumption was significantly less in group I than in group II (p < 0.05). No significant differences were found between the groups in the postoperative active knee flexion (n.s.). Side effects were similar between the groups. CONCLUSIONS: Transdermal fentanyl patches provide effective pain relief and decrease total rescue morphine consumption during the first 72 h after operation without additive side effects in patients undergoing TKA surgery.

The comparison of intraarticular morphine-bupivacaine and tramadol-bupivacaine in postoperative analgesia after arthroscopic anterior cruciate ligament reconstruction.

PURPOSE: To compare intraarticular morphine-bupivacaine and tramadol-bupivacaine as postoperative analgesics in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction. METHODS: A randomized, double blind, controlled trial study of 60 ASA I-II patients undergoing arthroscopic ACL reconstruction was performed under general anesthesia. Patients were randomly allocated into three groups. The MB group (n = 20) received 10 mg morphine and 0.5% bupivacaine; the TB group (n = 20) received 100 mg tramadol and 0.5% bupivacaine; and the control group (n = 20) received isotonic saline intraarticularly in a total volume of 20 ml after the operation. Postoperative pain was assessed with visual analogue scale (VAS) at 0, 30, 60, 90 min and 2, 4, 6, 12, 24 h being at rest. Analgesic duration as defined was the time of first request for analgesics, the first 24 h analgesic consumption, time to unassisted ambulation, discharge time and incidence of side effects were also evaluated. RESULTS: The VAS scores at 30, 60, 90 min and 2, 4, 12, 24 h were significantly less in the MB and TB groups in comparison with the control group (P < 0.05); VAS scores also decreased significantly in the MB group compared to the TB group at 2, 4 and 24 h (P < 0.05). Analgesic duration was longer and analgesic consumption was substantially less in the MB group (P < 0.05). Moreover, unassisted ambulation time and discharge time were significantly shorter in the MB group than the TB and control groups (P < 0.05). Side effects were similar among the groups. CONCLUSIONS: Intraarticular morphine-bupivacaine provides effective pain relief, longer analgesic duration, less analgesic requirement, shorter unassisted ambulation and discharge time were compared with intraarticular tramadol-bupivacaine after ACL reconstruction arthroscopy. LEVEL OF EVIDENCE: I.

Additive effects of low-level laser therapy with exercise on subacromial syndrome: a randomised, double-blind, controlled trial.

The subacromial syndrome is the most common source of shoulder pain. The mainstays of conservative treatment are non-steroidal anti-inflammatory drugs and exercise therapy. Recently, low-level laser therapy (LLLT) has been popularized in the treatment of various musculoskeletal disorders. The aim of this study is to evaluate the additive effects of LLLT with exercise in comparison with exercise therapy alone in treatment of the subacromial syndrome. We conducted a randomised clinical study of 80 patients who presented to clinic with subacromial syndrome (rotator cuff and biceps tendinitis). Patients were randomly allocated into two groups. In group I (n = 40), patients were given laser treatment (pulsed infrared laser) and exercise therapy for ten sessions during a period of 2 weeks. In group II (n = 40), placebo laser and the same exercise therapy were given for the same period. Patients were evaluated for the pain with visual analogue scale (VAS) and shoulder range of motion (ROM) in an active and passive movement of flexion, abduction and external rotation before and after treatment. In both groups, significant post-treatment improvements were achieved in all parameters (P = 0.00). In comparison between the two groups, a significant improvement was noted in all movements in group I (P = 0.00). Also, there was a substantial difference between the groups in VAS scores (P = 0.00) which showed significant pain reduction in group I. This study indicates that LLLT combined exercise is more effective than exercise therapy alone in relieving pain and in improving the shoulder ROM in patients with subacromial syndrome.