Comparison of Intraarticular Bupivacaine With the Addition of Morphine or Fentanyl for Analgesia After Arthroscopic Surgery Asuman Uysalel, M.D., Yiiksel Keqik, M.D., Pakize Kirdemir, M.D., Murat Sayin, M.D., and Mehmet Binnet, M.D. Summary: A randomized study on 30 patients undergoing knee arthroscopy was performed. Group I (n = 15) received 50 mg of 0.25% bupivacaine and 1 mg of morphine, and group II (n = 15) received 50 mg of 0.25% bupivacaine and 100 pg of fentanyl. The visual analogue scale was recorded at intervals of 1, 2, 3, 4, 6, 12, 24, and 48 hours after the operation. Supplementary analgesia requirements were also recorded. In group I, pain scores were lower than group II (P < .05) during the lst, 2nd, 3rd, 12th, 24th, and 48th hours. The duration of analgesia on group I was significantly longer than group II. The combination of intraarticular morphine and bupivacaine has a longer analgesic duration and effect than a combi- nation of fentanyl and bupivacaine. Key Words: Analgesics-Opioid-Fen- tanyl-Morphine-Local anesthetic-Bupivacaine-Postoperative pain. A dministration of local anesthetic drugs intraarticu- larly is very popular in arthroscopic surgery in that it provides postoperative pain relief and early dis- charge. 1-3Even though there are many studies related to intraarticular injection of local anesthetics, there are very few studies related to intraarticular administration of opioids. Recent studies showed that opioids produce effective analgesia through activation of opioid recep- tors in peripheral tissue.4 In our study, patients received low doses of mor- phine and fentanyl in addition to local anesthetics. MATERIALS AND METHODS We performed a randomized study on 30 patients undergoing arthroscopic surgery of the knee joint in From the Faculty of Medicine, The University of Ankara, Ankara, Turkey. Address correspondence and reprint requests to Asuman Uysalel, M.D., Ankara iiniversitesi Tip Fakiiltesi, Anesteziyoloji ve Reanima- syon A.B.D., ibn-i Sina Hastanesi, Sihhiye Ankara, Turkey. 0 1995 by the Arthroscopy Association of North America 0749-8063/95/l 106-1088$3.00/0 the Department of Orthopaedic Surgery and Trau- matology, ibn-i Sina Hospital, University of Ankara Faculty of Medicine (Table 1). In both groups, the same kind of operation was performed by the same surgeon under general anesthesia (Table 2). In both groups, agents were given 20 mL diluted solution of saline intra-articularly at the end of arthroscopic sur- gery by the orthopaedic surgeon. Group I (n = 15) received 50 mg of 0.25% bupivacaine and 1 mg of morphine (10 mL bupivacaine 0.5% solution, 10 mL normal saline, and 1 mg morphine). Group II (n = 15) received 50 mg of 0.25% bupivacaine and 100 pg of fentanyl (10 mL bupivacaine 0.5% solution, 10 mL normal saline, and 100 pg fentanyl). An observer blind to the agents injected recorded the visual analogue scale (VAS) at intervals of 1, 2, 3, 4, 6, 12, 24, and 48 hours after the operation. The blood pressure, heart rate, and respiratory rate were recorded. Postoperative pain was assessed at intervals by a VAS and require- ments for supplementary analgesia were recorded. The results are expressed as mean and standard error of mean (SEM) and analyzed using paired Student’s t-test. 660 Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 11, No 6 (December), 1995: pp 660-663