Intraarticular Morphine in the Multimodal Analgesic Management of Postoperative Pain After Ambulatory Anterior Cruciate Ligament Repair

Reconstruction of the anterior cruciate ligament (ACL) is associated with a considerable degree of postoperative pain.Our customary multimodal approach to postoperative analgesia after ambulatory ACL surgery includes perioperative nonsteroidal antiinflammatory drugs, pre- and postincisional intraarticular (IA) bupivacaine (B), and postoperative cryotherapy using an external cooling system. This study was designed to determine whether the addition of IA morphine (MS) provides improved postoperative analgesia. One hundred patients scheduled for elective ambulatory ACL repair received our standard multimodal therapy. After surgery, patients were randomized to one of four study groups. Group 1 received 30 mL of 0.25% B IA. Group 2 received 30 mL of normal saline IA and 5 mg of MSIA. Group 3 received 30 mL of 0.25% bupivacaine IA and 5 mg of MS IV. Group 4 received 30 mL of 0.25% B IA and 5 mg of MS IA. The addition of IA B postoperatively provided prolonged analgesia and decreased postoperative pain and analgesic requirements. The addition of MS to IA B did not provide additional postoperative analgesia. We conclude that patients undergoing ambulatory ACL repair using our standard multimodal analgesic regimen failed to receive additional postoperative analgesia when MS was added to the IA B. Implications: Patients receiving a multimodal analgesic regimen of perioperative nonsteroidal antiinflammatory drugs, intraarticular bupivacaine, and external cooling did not receive any additional analgesia from intraarticular morphine. (Anesth Analg 1998;86:374-8)