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<a href="http://doi.org/10.1093/bja/aeh222" target="_blank" rel="noreferrer">http://doi.org/10.1093/bja/aeh222</a>
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Title
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Increased numbers of opioid expressing inflammatory cells do not affect intra-articular morphine analgesia
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British Journal Of Anaesthesia
Date
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2004
Subject
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Female; Humans; Male; Adult; Analgesics; Aged; Middle Aged; Drug Therapy; Double-Blind Method; Biomarkers of Pain; Injections; Dose-Response Relationship; Drug; Opioid/administration & dosage; Receptors; Arthroscopy; Intra-Articular; Morphine/administration & dosage; Pain Measurement/methods; Combination; Knee Joint/metabolism/surgery; Opioid/metabolism; Pirinitramide/administration & dosage; Synovitis/metabolism/pathology
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Likar R; Mousa SA; Philippitsch G; Steinkellner H; Koppert W; Stein C; Schafer M
Description
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BACKGROUND: Both locally expressed beta-endorphin (END) and low doses of morphine relieve pain within inflamed knee joints. Here we examined whether enhanced inflammation and END expression within the synovial tissue of patients undergoing arthroscopic knee surgery might shift the analgesic dose-response curve of intra-articular (i.a.) morphine. METHODS: Following IRB approval and informed consent, patients were randomly assigned to the following i.a. treatments at the end of surgery: group I (n=39), isotonic saline; group II (n=40), 1 mg morphine hydrochloride; group III (n=48), 2 mg morphine hydrochloride; group IV (n=39), 4 mg morphine hydrochloride. Postoperative pain intensity was assessed by the visual analogue scale (VAS), by the time to first analgesic request and by the supplemental piritramide consumption. Synovial specimens from each patient were stained for the presence of inflammatory cells and END and were discriminated into groups with low versus high numbers of these cells. Differences between groups were statistically analyzed by chi(2), anova and mancova where appropiate. RESULTS: Patient characteristics and VAS scores did not differ between groups. Total postoperative piritramide consumption decreased and the time to first analgesic request increased significantly with increasing doses of i.a. morphine (P0.05, mancova). CONCLUSIONS: The dose-response relationship of i.a. morphine analgesia is not shifted by enhanced inflammation and END expression within synovial tissue. Thus, the presence of END within inflamed synovial tissue does not seem to interfere with i.a. morphine analgesia.
2004
Identifier
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<a href="http://doi.org/10.1093/bja/aeh222" target="_blank" rel="noreferrer">10.1093/bja/aeh222</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
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Journal Article
2004
Adult
Aged
Analgesics
Arthroscopy
Backlog
Biomarkers of Pain
British Journal Of Anaesthesia
Combination
Dose-Response Relationship
Double-Blind Method
Drug
Drug Therapy
Female
Humans
Injections
Intra-Articular
Journal Article
Knee Joint/metabolism/surgery
Koppert W
Likar R
Male
Middle Aged
Morphine/administration & dosage
Mousa SA
Opioid/administration & dosage
Opioid/metabolism
Pain Measurement/methods
Philippitsch G
Pirinitramide/administration & dosage
Receptors
Schafer M
Stein C
Steinkellner H
Synovitis/metabolism/pathology