scholarly journals INTRAARTICULAR MORPHINE FOR POST OPERATIVE KNEE ARTHROSCOPY ANALGESIA

2004 ◽  
Vol 43 (154) ◽  
Author(s):  
Deepak Prakash Mahara ◽  
A P Lamichhane
Keyword(s):  
Pain Relief ◽  
Opioid Receptors ◽  
Knee Arthroscopy ◽  
Cruciate Ligament ◽  
Good Alternative ◽  
Loose Bodies ◽  
Key Words Knee ◽  
Clinical Accuracy ◽  
Peripheral Opioid Receptors ◽  
Arthroscopic Procedures

Key Words: Knee arthroscopy, Morphine, Opioid receptors, Post-operative pain.The Arthroscopy has dramatically changed the orthopedic surgeon's approach to the diagnosis and treatmentof variety of joint ailments. A degree of clinical accuracy, combined with low morbidity has encouraged theuse of arthroscopy to assist in diagnosis to determine prognosis and often to provide treatment. Recentwork has described peripheral opioid receptors in skin and synovium. The later may respond to the use ofintra-articular morphine for analgesia following knee arthroscopy.Two hundred and twenty five patients who had undergone different arthroscopic procedures for the last 3and half years were prospectively evaluated. Of the total arthroscopic procedures evaluated, meniscalpathology was found in 154 patients, synovial pathology in 14 patients, Anterior CruciateLigament (ACL)and Posterior Cruciate Ligament (PCL) insufficiency in 18 patients, chondral lesions in 25 patients, tightlateral structures in 6 patients and loose bodies in 8 patients. All the patients were operated on outpatientbasis. Routine intra-articular morphine (2 mg.) was used for postoperative pain relief. Drain was not putfollowing the procedures. All the patients were seen on the 5th postoperative day. Most patients were satisfiedwith the pain relief modality and needed analgesics in few patients. Postoperative low dose intra-articularmorphine injection has been found to be good alternative to other pain management modalities.

Diagnostic Value of MRI and Radiographs of the Knee to Identify Osteochondral Lesions in Acute Patellar Instability

2021 ◽  
Author(s):  
Hayden Baker ◽  
Jason Dickherber ◽  
Manoj Reddy ◽  
Andrew Rizzi ◽  
Adam Kahn ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Osteochondral Defect ◽  
Knee Arthroscopy ◽  
Cruciate Ligament ◽  
Diagnostic Value ◽  
Mpfl Reconstruction ◽  
Osteochondral Lesions ◽  
Loose Bodies ◽  
Plain Radiographs ◽  
Diagnostic Arthroscopy

AbstractThe purpose of this study was to define the diagnostic value of magnetic resonance imaging (MRI) and plain radiographs (X-ray [XR]) in identifying an osteochondral defect or loose body in patients undergoing operative treatment for patellar instability. A total of 87 patients treated operatively for patellar instability with medial patellofemoral ligament (MPFL) reconstruction between 2015 and 2019 were identified. Inclusion criteria were evidence of clinical patellar instability, preoperative XR and MRI studies, and concomitant diagnostic knee arthroscopy and MPFL reconstruction performed to address patellar instability. Patients were excluded if they had a history of prior procedure for patellar instability on the surgical knee, underwent MPFL reconstruction without concomitant diagnostic knee arthroscopy, or had an anterior cruciate ligament or posterior cruciate ligament deficient knee. Operative notes and arthroscopic images were reviewed to identify osteochondral or chondral injuries and loose bodies noted during diagnostic arthroscopy. The primary outcome was the identification of intra-articular loose bodies, chondral injury, or osteochondral defect on preoperative plain radiographs and MRI in patients with patellar instability. All MRIs were performed on a 3T MRI. The sensitivity and specificity of identifying loose bodies on MRI were 0.52 and 0.92 and on XR were 0.23 and 0.98, respectively. The sensitivity and specificity of identifying osteochondral lesions on MRI were 0.43 and 0.81 and on XR were 0.08 and 0.97, respectively. Of the 87 available reports, 45 (51%) described performing chondroplasty for Outerbridge grade II/III chondral lesions on diagnostic arthroscopy. In conclusion, MRI and XR are poorly sensitive at identifying loose bodies or osteochondral defects after patellar dislocations. The poor sensitivity of imaging studies must be considered when determining whether or not to recommend operative management to a patient with patellar instability. This is a Level IV, diagnostic study.

scholarly journals Impact of a Standardized Multimodal Analgesia Protocol on Opioid Prescriptions After Common Arthroscopic Procedures

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711987075 ◽  
Author(s):  
Christina J. Hajewski ◽  
Robert W. Westermann ◽  
Andrew Holte ◽  
Alan Shamrock ◽  
Matthew Bollier ◽  
...  
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Case Series ◽  
Multimodal Analgesia ◽  
Pain Medication ◽  
Time Of Surgery ◽  
Significant Difference ◽  
Arthroscopic Procedures

Background: Excessive prescription of opioids has become a national problem. Providers must attempt to decrease the amount of opioids prescribed while still providing patients with adequate pain relief after surgery. Hypothesis: Implementing a standardized multimodal analgesic protocol will decrease the amount of opioids prescribed at the time of surgery as well as the total amount of opioids dispensed postoperatively. Study Design: Case series; Level of evidence, 4. Methods: Patients who had undergone meniscectomy, rotator cuff repair (RCR), or anterior cruciate ligament (ACL) reconstruction at our institution were identified by Current Procedural Terminology code 12 months prior to and 6 months after the initiation of a standardized multimodal postoperative pain protocol. Records were reviewed to extract demographic data, amount of opioids prescribed at the time of surgery, amount and frequency of opioid refills, and call-ins regarding pain medication or its side effects. A Wilcoxon rank-sum test was used to evaluate differences in opioid prescriptions between pre- and postprotocol, and significance was set to P < .05. Results: The mean amount of opioids prescribed at the time of surgery decreased from 63.5 to 22.3 pills ( P < .0001) for meniscectomy, from 73.3 to 39.7 ( P < .0001) for ACL reconstruction, and from 75.6 to 39.8 ( P < .0001) for RCR. The percentage of patients receiving a refill of opioids during the postoperative period also decreased for all groups: from 13% to 4% ( P = .0051) for meniscectomy, 29.2% to 11.4% ( P = .0005) for ACL reconstruction, and 47.3% to 24.4% ( P < .0001) for RCR. There was no significant difference in patient calls regarding pain medication or its side effects. Conclusion: Institution of a standardized multimodal analgesia protocol significantly decreased the amount of opioids dispensed after common arthroscopic procedures. This reduction in the amount of opioids given on the day of surgery did not result in an increased demand for refills. Our study also demonstrated that 20 opioid pills were adequate for patients undergoing meniscectomy and 40 pills were adequate for ACL reconstruction and RCR in the majority of cases. This protocol serves as a way for providers to decrease the amount of opioids dispensed after surgery while providing patients with alternatives for pain relief.

scholarly journals Subcellular Pathways of β-Endorphin Synthesis, Processing, and Release from Immunocytes in Inflammatory Pain

Endocrinology ◽  
2004 ◽  
Vol 145 (3) ◽  
pp. 1331-1341 ◽  
Author(s):  
Shaaban A. Mousa ◽  
Mehdi Shakibaei ◽  
Nicolle Sitte ◽  
Michael Schäfer ◽  
Christoph Stein
Keyword(s):  
Opioid Receptors ◽  
Immune Cells ◽  
Inflammatory Pain ◽  
Secretory Granules ◽  
Inflammatory Cells ◽  
Opioid Peptide ◽  
Active Peptides ◽  
Carboxypeptidase E ◽  
Peripheral Opioid Receptors

Abstract The opioid peptide β-endorphin (END) as well as mRNA for its precursor proopiomelanocortin (POMC) are found not only in the pituitary gland, but also within various types of immune cells infiltrating inflamed sc tissue. During stressful stimuli END is released and interacts with peripheral opioid receptors to inhibit pain. However, the subcellular pathways of POMC processing and END release have not yet been delineated in inflammatory cells. The aim of the present study was to examine the presence of POMC, carboxypeptidase E, the prohormone convertases 1 (PC1), and 2 (PC2), PC2-binding protein 7B2, and the release of END from inflammatory cells in rats. Using immunohistochemistry we detected END and POMC alone or colocalized with PC1, PC2, carboxypeptidase E, and 7B2 in macrophages/monocytes, granulocytes, and lymphocytes of the blood and within inflamed sc paw tissue. Immunoelectron microscopy revealed that END is localized within secretory granules packed in membranous structures in macrophages, monocytes, granulocytes, and lymphocytes. Finally, END is released by noradrenaline from immune cells in vitro. Taken together, our results indicate that immune cells express the entire machinery required for POMC processing into functionally active peptides such as END and are able to release these peptides from secretory granules.

scholarly journals POST-OPERATIVE PAIN RELIEF FOR LOWER ABDOMINAL SURGERY

2005 ◽  
Vol 12 (03) ◽  
pp. 340-345
Author(s):  
ROBINA FIRDOUS
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Pain Relief ◽  
Abdominal Surgery ◽  
Opioid Receptors ◽  
Acute Pain ◽  
Alternate Route ◽  
Parenteral Route ◽  
Group I ◽  
Post Operative Pain

The severity of post-operative pain and the lack of efforts in relievingit have led to the involvement of Anaesthesiologists in the management of post-operative and acute pain. Parenteralopiates have been utilized for post-operative pain management. The identification of the opioid receptors on substantiagelatinosa has provided an alternate route i.e 1 the epidural route - for administering opiates. Objectives: To evaluateand compare the efficacy and side effects of parenteral Buprenorphine with those of Extradural Buprenorphine.Setting: Department of Anaesthesia, District Headquarter Hospital, Faisalabad. Period: The data was collected duringthe last three and a half years. Materials and Methods: Sixty adult patients of either sex and ages ranging from 35-45years, who underwent lower abdominal surgery, were randomly selected for the study. They were equally divided intotwo groups. Group I patients were administered Buprenorphine 0.3 mg through the epidural catheter in extraduralspace. Group II patients were given Buprenorphine 0.3 mg intramuscularly. Results: Buprenorphine through theepidural route gives better analgesia with fewer side effects as compared with the parenteral route.

scholarly journals EFFECTS OF NEW PIPERIDINE DERIVATIVES WITH SUBSTITUTIONS IN THE 1ST AND 4TH POSITIONS IN NALOXONE SENSITIVE ANALGESY

2021 ◽  
Vol 19 (5) ◽  
pp. 501-505
Author(s):  
A. A. Vasilyuk ◽  
◽  
V. I. Kozlovsky ◽  
G. S. Akhmetova ◽  
V. K. Yu ◽  
...  
Keyword(s):  
Pain Relief ◽  
Receptor Antagonist ◽  
Opioid Receptor ◽  
Opioid Receptors ◽  
Analgesic Effect ◽  
Chemical Stimulation ◽  
Analgesic Action ◽  
Preliminary Administration ◽  
Chemical Irritation

Background. Despite the wide arsenal of painkillers, pain relief is an urgent interdisciplinary problem that requires a search for new solutions. Purpose of the study. To establish the role of opioid receptors in the mechanism of the analgesic action of the piperidine derivatives AGV-22 and AGV-23. Material and methods. The studies were carried out on 96 white mice of both sexes weighing 30-40 g. The analgesic effect of the compounds was tested on models of thermal and chemical irritation with preliminary administration of the opioid receptor antagonist naloxone. Results. The pain reactions of mice with models of thermal and chemical stimulation in the AGV-22 / AGV-23 + naloxone and AGV-22 / AGV-23 groups were comparable. Conclusions. The mechanism of the analgesic action of the piperidine derivatives AGV-22 and AGV-23 is not associated with the activation of opioid receptors.

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