Comparison of intra-articular and epidural morphine for analgesia following stifle arthrotomy in dogs.

We prospectively studied 18 dogs that presented for exploratory stifle arthrotomy, with or without meniscectomy, and lateral extracapsular stabilization as a result of cranial cruciate ligament rupture. Dogs were premedicated with acepromazine, induced with thiopental, and maintained with halothane in oxygen. Preoperatively, dogs were assigned to one of three groups. Group 1 (n = 6) received intra-articular morphine (0.1 mg/kg diluted in 1 mL/10 kg body weight of saline) and epidural saline (1 mL/5 kg body weight saline plus the volume of saline representing 0.1 mg/kg of morphine). Group 2 (n = 6) received intra-articular saline (1 mL/10 kg body weight of saline plus the volume of saline representing 0.1 mg/kg of morphine) and epidural saline (1 mL/5 kg body weight saline plus the volume of saline representing 0.1 mg/kg of morphine). Group 3 (n = 6) received intra-articular saline (1 mL/10 kg body weight of saline plus the volume of saline representing 0.1 mg/kg of morphine) and epidural morphine (0.1 mg/kg of morphine diluted in 1 mL/5 kg body weight saline). The efficacy of each analgesia regimen was evaluated for 6 hours postoperatively with a pain score based on subjective and objective variables. Serum cortisol and blood glucose concentrations were measured. Butorphanol was used to provide analgesia as needed based on a predetermined maximum pain score. Supplemental analgesics were required postoperatively every 2 to 3 hours for 6 hours in all dogs that did not initially receive analgesics (group 2). Pain scores were significantly lower in dogs administered morphine intra-articularly (group 1) and epidurally (group 3) at 30 minutes and 30, 120, and 360 minutes, respectively, compared with dogs that did not initially receive analgesics (group 2). One dog in group 1 and one dog in group 3 required supplemental analgesia with butorphanol. There was no difference between analgesia produced by intra-articular morphine compared with that of epidural morphine. Side effects after intra-articular or epidural morphine were not observed. Intra-articular administration of morphine can produce effective analgesia in dogs comparable with that produced by epidural administration of morphine.

[1]  D. Brockman,et al.  Analgesia in dogs after intercostal thoracotomy: a clinical trial comparing intravenous buprenorphine and interpleural bupivacaine. , 1994, Veterinary surgery : VS.

[2]  J. Froekjaer,et al.  Low-dose intra-articular morphine analgesia in day case knee arthroscopy: A randomized double-blinded prospective study , 1994, Pain.

[3]  J. Bellver,et al.  A Comparative Study of Analgesia After Knee Surgery with Intraarticular Bupivacaine, Intraarticular Morphine, and Lumbar Plexus Block , 1993, Anesthesia and analgesia.

[4]  Donald H. Johnson,et al.  Postarthroscopy Analgesia with Intraarticular Bupivacaine/Morphine: A Randomized Clinical Trial , 1993, Anesthesiology.

[5]  Kenneth D. Craig,et al.  Pain in the preterm neonate: behavioural and physiological indices , 1993, Pain.

[6]  G. Joshi,et al.  Intraarticular Analgesia Following Knee Arthroscopy , 1993, Anesthesia and analgesia.

[7]  C. Stein,et al.  Peripheral Mechanisms of Opioid Analgesia , 1993, Anesthesia and analgesia.

[8]  A. Lawrence,et al.  Intra-articular morphine for pain relief after knee arthroscopy. , 1992, The Journal of bone and joint surgery. British volume.

[9]  C. Ecoffey,et al.  IS PREOPERATIVE COAGULATION SCREENING USEFUL TONSILECTOMY AND/OR ADENOIDECTOMY? , 1992 .

[10]  B. Kavanagh,et al.  Preemptive analgesia. Clinical evidence of neuroplasticity contributing to postoperative pain. , 1992, Anesthesiology.

[11]  A. Chen,et al.  Intraarticular morphine, bupivacaine, and morphine/bupivacaine for pain control after knee videoarthroscopy. , 1992, Anesthesiology.

[12]  A. Herz,et al.  Analgesic effect of intraarticular morphine after arthroscopic knee surgery. , 1991, The New England journal of medicine.

[13]  B. Stevens,et al.  Pain assessment in newborns. , 1990, The Journal of perinatal & neonatal nursing.

[14]  M. Broome,et al.  Differentiating between pain and agitation in premature neonates. , 1990, The Journal of perinatal & neonatal nursing.

[15]  A. Herz,et al.  Intrinsic mechanisms of antinociception in inflammation: local opioid receptors and beta-endorphin , 1990, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[16]  Torben Æ. Mogensen,et al.  Prevention of postoperative pain by balanced analgesia. , 1990, British journal of anaesthesia.

[17]  R. Bednarski.  Anesthesia and pain control. , 1989, The Veterinary clinics of North America. Small animal practice.

[18]  A. Valverde,et al.  Epidural morphine reduces halothane MAC in the dog , 1989, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[19]  H. Kehlet.  Surgical stress: the role of pain and analgesia. , 1989, British journal of anaesthesia.

[20]  T. Shippenberg,et al.  Peripheral opioid receptors mediating antinociception in inflammation. Evidence for involvement of mu, delta and kappa receptors. , 1989, The Journal of pharmacology and experimental therapeutics.

[21]  A. Herz,et al.  Antinociceptive effects of μ- and κ-agonists in inflammation are enhanced by a peripheral opioid receptor-specific mechanism , 1988 .

[22]  R. Hines,et al.  ACTA NEW APPROACH , 1988 .

[23]  R. Dubner,et al.  Opioid Analgesia at Peripheral Sites: A Target for Opioids Released during Stress and Inflammation? , 1987, Anesthesia and analgesia.

[24]  J. Kinney,et al.  SPLANCHNIC OXYGEN CONSUMPTION AND SUBSTRATE RALANCE FOLLOWING ACCIDENTAL INJURY , 1984 .

[25]  L. Jorfeldt,et al.  Effects of the extradural administration of morphine, or bupivacaine, on the endocrine response to upper abdominal surgery. , 1984, British journal of anaesthesia.

[26]  L. Iversen,et al.  Multiple opiate receptor sites on primary afferent fibres , 1980, Nature.

[27]  J. Junien,et al.  Role of opioids in peripheral analgesia. , 1992, Life sciences.

[28]  P. Pascoe,et al.  Use of Epidural Morphine in the Dog for Pain Relief , 1989, Veterinary and Comparative Orthopaedics and Traumatology.