Original Article
Analgesic Effect of Intraarticular Morphine after Arthroscopic Knee Surgery
N Engl J Med 1991; 325:1123-1126October 17, 1991
- Abstract
- Abstract
Background.
Opioids can produce potent antinociceptive effects by interacting with local opioid receptors in inflamed peripheral tissue. In this study we examined the analgesic effects of the intraarticular, as compared with intravenous, administration of morphine after arthroscopic knee surgery.
Methods.
In a double-blind, randomized trial, we studied 52 patients who had received one of four injections at the end of surgery. The patients in group 1 (n = 18) received 1 mg of morphine intraarticularly and saline intravenously; those in group 2 (n = 15), saline intraarticularly and 1 mg of morphine intravenously; those in group 3 (n = 10), 0.5 mg of morphine intraarticularly and saline intravenously; and those in group 4 (n = 9), 1 mg of morphine and 0.1 mg of naloxone intraarticularly and saline intravenously. The volume of the intraarticular injections was 40 ml, and that of the intravenous injections was 1 ml. After 1, 2, 3, 4, 6, and 24 hours, postoperative pain was assessed with a visual-analogue scale, a numerical-rating scale, and the McGill pain questionnaire. The need for supplemental analgesic agents, the patients' vital signs, and the occurrence of side effects were monitored.
Results.
All pain scores were lower in group 1 than in group 2 at all times. The differences were significant (P<0.05) at three, four, and six hours (mean [±SD] visual-analogue score at six hours, 9±13 mm vs. 37±31 mm). The mean (±SD) consumption of supplemental analgesic medication per 24 hours was significantly lower in group 1 (36±51 mg of diclofenac and 1.2±3.4 mg of meperidine) than in group 2 (75±42 mg of diclofenac and 14±18 mg of meperidine, P<0.05). The visual-analogue scores in group 3 were slightly but not significantly higher than those in group 1 at all times except 6 and 24 hours after injection. The visual-analogue scores were significantly higher in group 4 than in group 1 one to four hours after injection (P<0.05), indicating that the analgesic effect of intraarticular morphine was reversible by naloxone.
Conclusions.
Low doses of intraarticular morphine can significantly reduce pain after knee surgery through an action specific to local opioid receptors that reaches its maximal effect three to six hours after injection. (N Engl J Med 1991;325:1123–6.)
Media in This Article
Figure 1
Mean (±SE) Pain Scores in Patients Who Underwent Arthroscopic Knee Surgery and Received 1 mg of Morphine Intraarticularly (•) or Intravenously (○).Table 1
Characteristics of Patients Undergoing Arthroscopic Knee Surgery.*Article Activity
- Article
OPIOID analgesia has been associated with the activation of opioid receptors in the central nervous system. Recently, however, we and others have demonstrated that exogenous1-3 as well as endogenous4 , 5 opioid agonists have peripheral antinociceptive effects in inflamed tissue of rats. We were able to distinguish the types of opioid receptors involved6 , 7 and to demonstrate the existence of such receptors on peripheral terminals of primary afferent neurons both functionally8 and morphologically.5 Possible analgesic effects resulting from the administration of opioids in the vicinity of peripheral sensory-nerve terminals have not been studied in humans.
This study was designed to investigate the analgesic effect of the intraarticular administration of low doses of morphine on postoperative pain in patients who were undergoing arthroscopic knee surgery, whether the effect was dose-dependent and reversible by naloxone, and whether there were side effects. The finding of more pronounced analgesic effects after local administration of an agonist than after systemic administration of an equal dose of the agonist would provide evidence for a peripheral site of action, and a finding of reversibility by naloxone would indicate a mechanism of action specific to opioid receptors.
Methods
Patients
The study protocol was approved by our institutional ethics committee, and written informed consent was obtained from each patient on the day before surgery. We studied 52 patients undergoing arthroscopic knee surgery (Table 1Table 1
Characteristics of Patients Undergoing Arthroscopic Knee Surgery.*). The surgical procedures included excision of tissue for diagnostic purposes, partial or total meniscectomy, and repair of ruptured ligaments, with approximately equal representation among the study groups. The criteria for exclusion from the study were evidence of severe cardiovascular, respiratory, metabolic, or neurologic disease and the need for intraarticular drainage after surgery. Anesthesia was induced with fentanyl (0.1 mg), vecuronium (2 mg), thiopental (4 mg per kilogram of body weight), and succinylcholine (1 mg per kilogram) and was maintained with oxygen—nitrous oxide and isoflurane, with supplemental doses of vecuronium as needed.Study Design
At the conclusion of surgery, before the arthroscope was removed, the following solutions were injected simultaneously: group 1 (n = 18) received 1 mg of morphine hydrochloride (Merck, Darmstadt, Germany) in 40 ml of normal saline intraarticularly and 1 ml of normal saline intravenously; as a control for the systemic absorption of morphine, group 2 (n = 15) received 40 ml of saline intraarticularly and 1 mg of morphine intravenously; group 3 (n = 10) received 0.5 mg of morphine in 40 ml of saline intraarticularly and 1 ml of saline intravenously; and group 4 (n = 9) received 1 mg of morphine together with 0.1 mg of naloxone (Dupont, Bad Homburg, Germany) in 40 ml of saline intraarticularly and 1 ml of saline intravenously. These doses were chosen on the basis of previous experiments in animals.3 , 6 , 7 The solutions were drawn into two coded syringes by a nurse and given to the investigator administering the injections, who did not know their contents. General anesthesia was then terminated. The study was performed in two consecutive phases, first in groups 1 and 2 and then in groups 3 and 4. In each phase the nurse randomly assigned the patients to one of the two groups. The codes were broken at the end of each phase.
Assessment of Pain
Postoperative pain was assessed with a 100-mm visual-analogue scale ranging from no pain (0 mm) to unbearable pain (100 mm), a numerical-rating scale (0 to 100), and a German adaptation of the McGill pain questionnaire.9-11 The use of these measures of pain was explained to each patient on the day before surgery. The scores were obtained by the same investigator 1, 2, 3, 4, 6, and 24 hours after the injection of the drugs. Supplemental analgesic medication (intravenous meperidine, intravenous piritramide, and diclofenac suppositories) was available on request. The choice of supplemental medication was left to the attending physician's clinical judgment.
Assessment of Vital Signs and Side Effects
The blood pressure, heart rate, respiratory rate, somnolence score, and any side effects were recorded 1, 2, 3, 4, 6, and 24 hours after injection. Somnolence was assessed with a five-point scale ranging from "awake and oriented" to "not arousable." The side effects we monitored included pruritus, nausea, urinary retention, and rash.
Statistical Analysis
Demographic data, vital signs, and the occurrence of side effects were analyzed by analysis of variance.12 To obtain the visual-analogue score, we measured the distance in millimeters from 0 (no pain) to the mark provided by the patient. To score the McGill pain questionnaire, pain-rating indexes based on the patients' mean scale values were calculated for each category (sensory, affective, evaluative, and miscellaneous) and for all categories (total), and the words describing pain that the patients chose in each category were counted, according to the system of Melzack.13 To determine the need for supplemental analgesic agents, the total consumption of diclofenac per 24 hours was recorded for each patient, as was the consumption of piritramide and meperidine. Doses of piritramide were converted to meperidine equivalents on the basis of a relative analgesic potency of two to one.14 These values were added to those for meperidine to yield the total requirements for the first 24 hours for each patient. We compared the pain scores and analgesic requirements in groups 1 and 2 using the Mann—Whitney U test. The Bonferroni correction was applied as appropriate. Comparisons between groups 1 and 3 and groups 1 and 4 were performed in the same fashion. The results are given as means ±SD except where indicated. A two-tailed P value of less than 0.05 was considered to indicate statistical significance.
Results
There were no significant differences in the demographic characteristics of the patients in the four groups (Table 1) or in their vital signs or sedation scores at any time (data not shown). Apart from nausea immediately after the termination of general anesthesia, which was reported by eight patients distributed evenly among the groups, no patient had any major side effects.
All pain scores were lower in group 1 (which received 1 mg of intraarticular morphine) than group 2 (1 mg of intravenous morphine) at all times (Fig. 1Figure 1
Mean (±SE) Pain Scores in Patients Who Underwent Arthroscopic Knee Surgery and Received 1 mg of Morphine Intraarticularly (•) or Intravenously (○). and Table 2Table 2
Mean (±SD) Visual-Analogue Scores Assessing Pain in Patients Who Received Intraarticular or Intravenous Morphine after Arthroscopic Knee Surgery.). The differences were significant three, four, and six hours after the injection of the drug (Fig. 1 and Table 2). The sensory-pain-rating indexes were not significantly different from the total pain-rating indexes at any time in any group (data not shown). The need for supplemental analgesic agents was significantly lower in group 1 (36±51 mg of diclofenac and 1.2±3.4 mg of meperidine) than group 2 (75±42 mg of diclofenac and 14±18 mg of meperidine).The visual-analogue scores in group 3 (which received 0.5 mg of intraarticular morphine) were slightly but not significantly higher than those in group 1 at all times except 6 and 24 hours after the injection (Table 2). The need for supplemental analgesic agents in group 3 (20±42 mg of diclofenac and 5±10 mg of meperidine) was not significantly different from that in group 1.
The reduction in pain scores produced by intraarticular morphine was counteracted by the concomitant intraarticular administration of naloxone. The visual-analogue scores in group 4 (which received 1 mg of morphine and 0.1 mg of naloxone intraarticularly) were higher than those in group 1 at all times except 24 hours after the injection (Table 2). This difference was significant at one, two, three, and four hours. The need for supplemental analgesic agents in group 4 (78 ±44 mg of diclofenac and no meperidine) was not significantly different from that in group 1.
In groups 3 and 4 the assessments of pain according to the numerical-rating scale and the McGill pain questionnaire were similar to the respective visual-analogue scores (data not shown).
Discussion
We found that after arthroscopic knee surgery a low dose of intraarticular morphine produced more pronounced postoperative analgesia than the same dose given intravenously, indicating that morphine has a peripheral site of action in the knee joint. The analgesic effect was reversed by naloxone. These results, in conjunction with our results in animals,3 , 7 suggest that the effect is mediated by local opioid receptors in the joint.
The analgesic effect of intraarticular morphine was demonstrated by three subjective measures of pain, the visual-analogue scale, the numerical-rating scale, and the McGill pain questionnaire. The first two scales are designed to measure the intensity of pain,10 whereas the McGill questionnaire discriminates between the sensory and affective—evaluative dimensions of pain.11 , 13 As one would anticipate with postoperative pain, generally considered to be acute somatic pain, the descriptors the patients chose on the McGill pain questionnaire were almost exclusively from the sensory category. On all the tests, the patients who received intraarticular morphine had lower scores than those who received the same dose intravenously; the difference was greatest three to six hours after injection. Since the average duration of analgesia after an intravenous injection of morphine is approximately two to three hours,15 the longer duration with intraarticular morphine is noteworthy. The low lipid solubility of morphine,15 and therefore its slow rate of uptake into the circulation, is a possible explanation, as is the relatively low blood flow to the articular area. As an indirect indicator of the intensity of pain, the need for supplemental analgesic medication was significantly lower among the patients who received morphine intraarticularly than among those who received the same dose intravenously. In spite of the larger amount of supplemental medication taken by the patients who received intravenous morphine, the difference in reported pain scores was quite distinct. The difference might have been even greater without the supplemental medication, which for ethical reasons we could not withhold.
Does this peripheral analgesic effect of morphine result from interaction with opioid receptors? To address this issue we assessed the dose-dependency of the response and its reversibility by naloxone. Although the difference in results between the 0.5-mg and 1-mg doses of intraarticular morphine was not statistically significant, the pain scores were slightly lower with the higher dose, and intraarticular naloxone clearly counteracted morphine's peripheral analgesic effect. This antagonist effect was briefer than the agonist effect of intraarticular morphine (Table 2), indicating that the half-life of intraarticular naloxone was shorter than that of morphine, as is consistent with the known systemic half-lives of the drugs.15 Collectively, these data indicate that intraarticular morphine can elicit an analgesic effect specific to local opioid receptors.
The lack of major side effects after the intraarticular administration of morphine was noteworthy. The systemic and spinal administration of morphine for postoperative pain is limited by side effects such as respiratory depression, pruritus, and urinary retention. None of our patients who received morphine intraarticularly had any of these side effects.
In summary, low doses of intraarticular morphine can significantly attenuate postoperative pain in patients undergoing arthroscopic knee surgery. This effect appears to be specific to opioid receptors and is unaccompanied by major side effects.
Supported by the Deutsche Forschungsgemeinschaft and the International Anesthesia Research Society.
Presented in part in abstract form at the annual meeting of the American Society of Anesthesiologists, Las Vegas, October 1990, and at the annual meeting of the Arthroscopy Association of North America, San Diego, Calif., April 1991.
We are indebted to Mrs. G. Kahleis for assistance in the preparation of the manuscript; to Mrs. U. Bäuerle for preparing the figures; and to Drs. H.J. Refior, K. Fritsch, H. Kirchhübel, T. Witt, H.J. Stiebler, G. Mendl, and W. Weber and Mr. P. Jacobs for their invaluable cooperation.
Source Information
From the Departments of Anesthesiology (C.S., K.C., E.H., K.P.) and Orthopedics (K.L.), Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Munich, Germany; and the Departments of Neuropharmacology (A.H.) and Biostatistics (A.Y.), Max-Planck-Institut für Psychiatrie, Martinsried, Germany. Address reprint requests to Dr. Stein at the Department of Anesthesiology, Klinikum Grosshadern, D-8000 Munich 70, Germany.
- References
References
1
Ferreira
CrossRef | Web of Science | Medline2
Joris
CrossRef | Web of Science | Medline3
Stein
CrossRef | Web of Science | Medline4
Stein
Web of Science | Medline5
Stein
CrossRef | Web of Science | Medline6
Stein
CrossRef | Web of Science | Medline7
Stein
Web of Science | Medline8
Barthó
CrossRef | Web of Science | Medline9
Scott
CrossRef | Web of Science | Medline10
Chapman
CrossRef | Web of Science | Medline11
Stein
CrossRef | Web of Science | Medline12
Kirk RE. Experimental design: procedures for the behavioral sciences. 2nd ed. Monterey, Calif.: Brooks/Cole, 1982.
13
Melzack
CrossRef | Web of Science | Medline14
de Castro
Medline15
Jaffe JH, Martin WR. Opioid analgesics and antagonists. In: Gilman AG, Goodman LS, Rall TW, Murad F, eds. Goodman and Gilman's the pharmacological basis of therapeutics. 7th ed. New York: Macmillan, 1985:491–531.
- Citing Articles (179)
Citing Articles
1
Adrian J. Cassar Gheiti, Richard E. Downey, Damien P. Byrne, Diarmuid C. Molony, Kevin J. Mulhall. (2012) The 25 Most Cited Articles in Arthroscopic Orthopaedic Surgery. Arthroscopy: The Journal of Arthroscopic & Related Surgery
CrossRef2
Florian Haasters, Hans Polzer, Wolf Christian Prall, Maximilian Michael Saller, Julia Kohler, Stefan Grote, Wolf Mutschler, Denitsa Docheva, Matthias Schieker. (2011) Bupivacaine, ropivacaine, and morphine: comparison of toxicity on human hamstring-derived stem/progenitor cells. Knee Surgery, Sports Traumatology, Arthroscopy 19:12, 2138-2144
CrossRef3
Habibollah Hosseini, Seyyed Mohammad Jalil Abrisham, Hossein Jomeh, Mohammad Kermani-Alghoraishi, Rahil Ghahramani, Mohammad Reza Mozayan. (2011) The comparison of intraarticular morphine–bupivacaine and tramadol–bupivacaine in postoperative analgesia after arthroscopic anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy
CrossRef4
Stefano Coaccioli, Giustino Varrassi. (2011) Chronic Degenerative Pain. Journal of Clinical Gastroenterology 45, S94-S97
CrossRef5
Marc Fajardo, Jason Collins, Joshua Landa, Edward Adler, Patrick Meere, Paul E. Di Cesare. (2011) Effect of a Perioperative Intra-Articular Injection on Pain Control and Early Range of Motion Following Bilateral TKA. Orthopedics
CrossRef6
Zui Zou, Mao Mao An, Qun Xie, Xiao Y Chen, Hao Zhang, Guan J Liu, Xue Y Shi, Xue Y Shi. 2011. Single-dose intra-articular morphine for pain control after knee arthroscopy. .
CrossRef7
Kenneth D. Candido, Antoun Nader. 2011. Intra-articular and intraperitoneal opioids for postoperative pain. , 228-233.
CrossRef8
Zui Zou, Hong B Yuan, Xiao Y Chen, Guan J Liu, Xue Y Shi, Xue Y Shi. 2011. .
CrossRef9
Ella G. Faktorovich, Allan I. Basbaum. (2010) Effect of Topical 0.5% Morphine on Postoperative Pain After Photorefractive Keratectomy. Journal of Refractive Surgery 26:12, 934-941
CrossRef10
Ahmet Eroglu, Sebnem Saracoglu, Engin Erturk, Muge Kosucu, Servet Kerimoglu. (2010) A comparison of intraarticular morphine and bupivacaine for pain control and outpatient status after an arthroscopic knee surgery under a low dose of spinal anaesthesia. Knee Surgery, Sports Traumatology, Arthroscopy 18:11, 1487-1495
CrossRef11
Melanie Busch-Dienstfertig, Christoph Stein. (2010) Opioid receptors and opioid peptide-producing leukocytes in inflammatory pain – Basic and therapeutic aspects. Brain, Behavior, and Immunity 24:5, 683-694
CrossRef12
S. L. Kopp, T. T. Horlocker. (2010) Regional anaesthesia in day-stay and short-stay surgery. Anaesthesia 65, 84-96
CrossRef13
Casper Lindegaard, Maj H Thomsen, Stig Larsen, Pia H Andersen. (2010) Analgesic efficacy of intra-articular morphine in experimentally induced radiocarpal synovitis in horses. Veterinary Anaesthesia and Analgesia 37:2, 171-185
CrossRef14
Casper Lindegaard, Anna B Frost, Maj H Thomsen, Claus Larsen, Steen Honoré Hansen, Pia Haubro Andersen. (2010) Pharmacokinetics of intra-articular morphine in horses with lipopolysaccharide-induced synovitis. Veterinary Anaesthesia and Analgesia 37:2, 186-195
CrossRef15
Hilal Ayoglu, Hanife Altunkaya, Ahmet Bayar, Isil Ozkocak Turan, Yetkin Ozer, Ahmet Ege. (2010) The effect of intraarticular combinations of tramadol and ropivacaine with ketamine on postoperative pain after arthroscopic meniscectomy. Archives of Orthopaedic and Trauma Surgery 130:3, 307-312
CrossRef16
Kumi Moriyama, Jia Liu, Yeon Jang, Yun Jeong Chae, Yan Wang, James Mitchell, Stefan Grond, Xiaokang Han, Yilei Xing, Guo-xi Xie, Pamela Pierce Palmer. (2009) Receptor mediation and nociceptin inhibition of bradykinin-induced plasma extravasation in the knee joint of the rat. Inflammation Research 58:12, 873-880
CrossRef17
Luiz César Pereira Santos, Aury Nunes de Moraes, Mere Erika Saito. (2009) Effects of intraarticular ropivacaine and morphine on lipopolysaccharide-induced synovitis in horses. Veterinary Anaesthesia and Analgesia 36:3, 280-286
CrossRef18
Christoph Stein, J. David Clark, Uhtaek Oh, Michael R. Vasko, George L. Wilcox, Aaron C. Overland, Todd W. Vanderah, Robert H. Spencer. (2009) Peripheral mechanisms of pain and analgesia. Brain Research Reviews 60:1, 90-113
CrossRef19
R. Hube, M. Tröger, F. Rickerl, E. O. Muench, R. Eisenhart-Rothe, W. Hein, H. O. Mayr. (2009) Pre-emptive intra-articular administration of local anaesthetics/opiates versus postoperative local anaesthetics/opiates or local anaesthetics in arthroscopic surgery of the knee joint: a prospective randomized trial. Archives of Orthopaedic and Trauma Surgery 129:3, 343-348
CrossRef20
S. Barker. (2009) Analgesic effect of locally applied morphine to pyoderma gangrenosum. Clinical and Experimental Dermatology 34:1, 91-92
CrossRef21
Jacques Le Coz. 2009. Propriétés de la peau et modes d'actions présumés. , 9-15.
CrossRef22
M. I. Funez, L. F. Ferrari, D. B. Duarte, D. Sachs, F. Q. Cunha, B. B. Lorenzetti, C. A. Parada, S. H. Ferreira. (2008) Inaugural Article: Teleantagonism: A pharmacodynamic property of the primary nociceptive neuron. Proceedings of the National Academy of Sciences 105:49, 19038-19043
CrossRef23
Kotaro Mizuta, Tsugumi Fujita, Terumasa Nakatsuka, Eiichi Kumamoto. (2008) Inhibitory effects of opioids on compound action potentials in frog sciatic nerves and their chemical structures. Life Sciences 83:5-6, 198-207
CrossRef24
Celeste M. Hancock, Cheryl Riegger-Krugh. (2008) Modulation of Pain in Osteoarthritis. The Clinical Journal of Pain 24:4, 353-365
CrossRef25
Meera Kharbanda, Vikas Maheshwari. (2008) Evaluation of Intra-Articular Morphine for Postoperative Analgesia in Knee Arthroscopy as Compared to Bupivacaine. Apollo Medicine 5:1, 22-25
CrossRef26
SANJAY M. BHANANKER, LAWRENCE F. AZAVEDO, WILLIAM M. SPLINTER. (2008) Addition of morphine to local anesthetic infiltration does not improve analgesia after pediatric dental extractions. Pediatric Anesthesia 18:2, 140-144
CrossRef27
Elon Eisenberg. (2008) European Pain Management Discussion Forum. Journal of Pain and Palliative Care Pharmacotherapy 22:3, 235-238
CrossRef28
Brian A. Williams, Krystof J. Neumann, Shiv K. Goel, Christopher L. Wu. 2008. Postoperative Pain and Other Acute Pain Syndromes. , 299-334.
CrossRef29
John R. Zuniga, Carlos Ibanez, Mark Kozacko. (2007) The Analgesic Efficacy and Safety of Intra-Articular Morphine and Mepivicaine Following Temporomandibular Joint Arthroplasty. Journal of Oral and Maxillofacial Surgery 65:8, 1477-1485
CrossRef30
Amaury J. Pozos, Ricardo Martínez, Patricia Aguirre, José Pérez. (2007) Tramadol Administered in a Combination of Routes for Reducing Pain After Removal of an Impacted Mandibular Third Molar. Journal of Oral and Maxillofacial Surgery 65:8, 1633-1639
CrossRef31
Osei B. Ansah, Antti Pertovaara. (2007) Peripheral Suppression of Arthritic Pain by Intraarticular Fadolmidine, an ??2-Adrenoceptor Agonist, in the Rat. Anesthesia & Analgesia 105:1, 245-250
CrossRef32
Hermann O. Mayr, Elmar Entholzner, Robert Hube, Werner Hein, Thomas G. Weig. (2007) Pre- versus postoperative intraarticular application of local anesthetics and opioids versus femoral nerve block in anterior cruciate ligament repair. Archives of Orthopaedic and Trauma Surgery 127:4, 241-244
CrossRef33
Rudolf Likar, Shaaban A. Mousa, Hermann Steinkellner, Wolfgang Koppert, Gudrun Philippitsch, Christoph Stein, Michael Sch??fer. (2007) Involvement of Intra-articular Corticotropin-releasing Hormone in Postoperative Pain Modulation. The Clinical Journal of Pain 23:2, 136-142
CrossRef34
E. Viel, S. Jaber, J. Ripart, F. Navarro, J.-J. Eledjam. (2007) Analgesia postoperatoria nell’adulto (esclusa quella ambulatoriale). EMC - Anestesia-Rianimazione 12:2, 1-26
CrossRef35
Noufissa Kabli, Catherine Marie Cahill. (2007) Anti-allodynic effects of peripheral delta opioid receptors in neuropathic pain. Pain 127:1-2, 84-93
CrossRef36
Amol M. Patwardhan, Anibal Diogenes, Kelly A. Berg, Jill C. Fehrenbacher, William P. Clarke, Armen N. Akopian, Kenneth M. Hargreaves. (2006) PAR-2 agonists activate trigeminal nociceptors and induce functional competence in the delta opioid receptor. Pain 125:1-2, 114-124
CrossRef37
A. Sadjak, R. Wintersteiger, D. Zakel, T. Wenzl, E. P. Lankmayr, E. Gferer, R. Likar. (2006) Periphere analgetische Wirkung durch intraartikulär verabreichtes Clonidin. Der Schmerz 20:4, 293-299
CrossRef38
Jonas Bergström, Mahmood Ahmed, Jian Li, Tashfeen Ahmad, Andris Kreicbergs, Mariana Spetea. (2006) Opioid peptides and receptors in joint tissues: Study in the rat. Journal of Orthopaedic Research 24:6, 1193-1199
CrossRef39
Ana T.G. Guerrero, Waldiceu A. Verri, Thiago M. Cunha, Tarcilia A. Silva, Francisco A.C. Rocha, Sérgio H. Ferreira, Fernando Q. Cunha, Carlos A. Parada. (2006) Hypernociception elicited by tibio-tarsal joint flexion in mice: A novel experimental arthritis model for pharmacological screening. Pharmacology Biochemistry and Behavior 84:2, 244-251
CrossRef40
Subrata Basu Ray. (2006) Loperamide: A Potential Topical Analgesic for the Treatment of Burn Pain. Journal of Burn Care & Research 27:1, 121-122
CrossRef41
Mario I. Ortiz, Jhanet Castro-Olguín, Nayeli Peña-Samaniego, Gilberto Castañeda-Hernández. (2005) Probable activation of the opioid receptor-nitric oxide-cyclic GMP-K+ channels pathway by codeine. Pharmacology Biochemistry and Behavior 82:4, 695-703
CrossRef42
Paul F. White. (2005) The Changing Role of Non-Opioid Analgesic Techniques in the Management of Postoperative Pain. Anesthesia & Analgesia 101:Supplement, S5-S22
CrossRef43
Zongming Li, David Proud, Chunfen Zhang, Shahina Wiehler, Jason J. McDougall. (2005) Chronic arthritis down-regulates peripheral μ-opioid receptor expression with concomitant loss of endomorphin 1 antinociception. Arthritis & Rheumatism 52:10, 3210-3219
CrossRef44
Yatindra Kumar Batra, Rajesh Mahajan, Sushil Kumar Bangalia, Onkar Nath Nagi, Mandeep Singh Dhillon. (2005) Bupivacaine/ketamine is superior to intra-articu-lar ketamine analgesia following arthroscopic knee surgery. Canadian Journal of Anesthesia/Journal canadien d'anesthésie 52:8, 832-836
CrossRef45
J. Oeltjenbruns, M. Schäfer. (2005) Anwendungsmöglichkeiten und Stellenwert der peripheren Opioidanalgesie. Der Schmerz 19:5, 447-455
CrossRef46
Paul F. White. (2005) Update on ambulatory anesthesia. Canadian Journal of Anesthesia/Journal canadien d'anesthésie 52:S1, R45-R45
CrossRef47
R. Likar, M. Schäfer, E. Trampitsch, C. Breschan, R. Sittll, A. Gaggl, C. Stein. (2005) Topische Applikation von Lokalanästhetika und Opioiden nach elektiver Zahnextraktion. Der Schmerz 19:3, 195-200
CrossRef48
Ryan C. Goodwin, Firooz Amjadi, Richard D. Parker. (2005) Short-term analgesic effects of intra-articular injections after knee arthroscopy. Arthroscopy: The Journal of Arthroscopic & Related Surgery 21:3, 307-312
CrossRef49
Wiebke Puehler, Christoph Stein. (2005) Controlling Pain by Influencing Neurogenic Pathways. Rheumatic Disease Clinics of North America 31:1, 103-113
CrossRef50
Jochen Oeltjenbruns, Michael Schäfer. (2005) Peripheral opioid analgesia: Clinical applications. Current Pain and Headache Reports 9:1, 36-44
CrossRef51
Hans-Georg Schaible, Angela Del Rosso, Marco Matucci-Cerinic. (2005) Neurogenic Aspects of Inflammation. Rheumatic Disease Clinics of North America 31:1, 77-101
CrossRef52
Leiv A. Rosseland, Knut G. Helgesen, Harald Breivik, Audun Stubhaug. (2004) Moderate-to-Severe Pain After Knee Arthroscopy Is Relieved by Intraarticular Saline: A Randomized Controlled Trial. Anesthesia & Analgesia1546-1551
CrossRef53
Mehmet Kizilkaya, Omer Selim Yildirim, Nazim Dogan, Husnu Kursad, Ali Okur. (2004) Analgesic Effects of Intraarticular Sufentanil and Sufentanil Plus Methylprednisolone After Arthroscopic Knee Surgery. Anesthesia & Analgesia1062-1065
CrossRef54
Ahmet Dogrul, Husamettin Gul, Ahmet Akar, Oguzhan Yildiz, Ferruh Bilgin, Erdal Guzeldemir. (2003) Topical cannabinoid antinociception: synergy with spinal sites. Pain 105:1-2, 11-16
CrossRef55
L. A. Rosseland, A. Stubhaug, F. Grevbo, O. Reikeras, H. Breivik. (2003) Effective pain relief from intra-articular saline with or without morphine 2 mg in patients with moderate-to-severe pain after knee arthroscopy: a randomized, double-blind controlled clinical study. Acta Anaesthesiologica Scandinavica 47:6, 732-738
CrossRef56
Jesus M. Marchal, Alberto D. Delgado-Martinez, Mercedes Poncela, Juan Valenzuela, Juan de Dios Luna. (2003) Does the Type of Arthroscopic Surgery Modify the Analgesic Effect of Intraarticular Morphine and Bupivacaine? A Preliminary Study. The Clinical Journal of Pain 19:4, 240-246
CrossRef57
A Barin. (2003) Endomorphin-1 causes synovial hypoaemia in rat knee joints via a capsaicin-sensitive neural pathway. Neuroscience Letters
CrossRef58
J. Bergström, M. Ahmed, A. Kreicbergs, I. Nylander. (2003) Purification and quantification of opioid peptides in bone and joint tissues—a methodological study in the rat. Journal of Orthopaedic Research 21:3, 465-469
CrossRef59
I. Tegeder. (2003) Peripheral opioid analgesia in experimental human pain models. Brain 126:5, 1092-1102
CrossRef60
Maximilian W. B. Hartmannsgruber, Peter G. Atanassoff, Arne Budde, Sorin J. Brull, Zeev N. Kain, David G. Silverman. (2003) Intradermal sufentanil does not improve lidocaine-induced local anesthesia. Canadian Journal of Anesthesia/Journal canadien d'anesthésie 50:2, 153-158
CrossRef61
Halina Machelska, Christoph Stein. (2002) Immune Mechanisms in Pain Control. Anesthesia & Analgesia 95:4, 1002-1008
CrossRef62
Eija Kalso, Lesley Smith, Henry J McQuay, R Andrew Moore. (2002) No pain, no gain: clinical excellence and scientific rigour – lessons learned from IA morphine. Pain 98:3, 269-275
CrossRef63
Luciano Mastronardi, Marco Pappagallo, Fabrizio Puzzilli, Carlo Tatta. (2002) Efficacy of the Morphine-Adcon-L Compound in the Management of Postoperative Pain after Lumbar Microdiscectomy. Neurosurgery 50:3, 518-525
CrossRef64
F CLARK. (2001) REGIONAL ANALGESIA IN THE INTENSIVE CARE UNITPrinciples and Practice. Critical Care Clinics 17:4, 943-966
CrossRef65
Heike L. Rittner, Alexander Brack, Halina Machelska, Shaaban A. Mousa, Monika Bauer, Michael Schäfer, Christoph Stein. (2001) Opioid Peptide–expressing Leukocytes. Anesthesiology 95:2, 500-508
CrossRef66
Francesco Franceschi, Giacomo Rizzello, Rita Cataldo, Vincenzo Denaro. (2001) Comparison of morphine and ropivacaine following knee arthroscopy. Arthroscopy: The Journal of Arthroscopic & Related Surgery 17:5, 477-480
CrossRef67
Scott S. Reuben, Joseph Sklar, Mervhat El-Mansouri. (2001) The Preemptive Analgesic Effect of Intraarticular Bupivacaine and Morphine After Ambulatory Arthroscopic Knee Surgery. Anesthesia and Analgesia923-926
CrossRef68
Rudolf Likar, Wolfgang Koppert, Hubert Blatnig, Friedrich Chiari, Reinhard Sittl, Christoph Stein, Michael Schäfer. (2001) Efficacy of Peripheral Morphine Analgesia in Inflamed, Non-Inflamed and Perineural Tissue of Dental Surgery Patients. Journal of Pain and Symptom Management 21:4, 330-337
CrossRef69
Jan H. Vranken, Kris C. P. Vissers, Raf de Jongh, Rene Heylen. (2001) Intraarticular Sufentanil Administration Facilitates Recovery After Day-Case Knee Arthroscopy. Anesthesia and Analgesia 92:3, 625-628
CrossRef70
Jan H. Vranken, Kris C. P. Vissers, Raf de Jongh, Rene Heylen. (2001) Intraarticular Sufentanil Administration Facilitates Recovery After Day-Case Knee Arthroscopy. Anesthesia and Analgesia625-628
CrossRef71
John A Reichert, Randy S Daughters, Rachel Rivard, Donald A Simone. (2001) Peripheral and preemptive opioid antinociception in a mouse visceral pain model. Pain 89:2-3, 221-227
CrossRef72
Sd Silberstein, Dc McCrory. (2000) Opioids. Cephalalgia 20:10, 854-864
CrossRef73
Thomas M. Hemmerling, Wido M. Budde, Wolfgang Koppert, Jost B. Jonas. (2000) Retrobulbar Versus Systemic Application of Morphine During Titratable Regional Anesthesia via Retrobulbar Catheter in Intraocular Surgery. Anesthesia & Analgesia585-588
CrossRef74
Thomas M. Hemmerling, Wido M. Budde, Wolfgang Koppert, Jost B. Jonas. (2000) Retrobulbar Versus Systemic Application of Morphine During Titratable Regional Anesthesia via Retrobulbar Catheter in Intraocular Surgery. Anesthesia & Analgesia 91:3, 585-588
CrossRef75
H Machelska, C Stein. (2000) Pain Control by Immune-Derived Opioids. Clinical and Experimental Pharmacology and Physiology 27:7, 533-536
CrossRef76
Shung-Tai Ho, Jhi-Joung Wang, Johnson Jian-Sheng Tang, Wen-Jinn Liaw, Chiu-Ming Ho. (2000) Pain Relief After Arthroscopic Knee Surgery: Intravenous Morphine, Epidural Morphine, and Intra-Articular Morphine. The Clinical Journal of Pain 16:2, 105-109
CrossRef77
Ann L. Persson, Gert-Åke Hansson, Jarkko Kalliomäki, Ulrich Moritz, Bengt H. Sjölund. (2000) Pressure Pain Thresholds and Electromyographically Defined Muscular Fatigue Induced by a Muscular Endurance Test in Normal Women. The Clinical Journal of Pain 16:2, 155-163
CrossRef78
L. Magistris, A. Casati, A. Albertin, F. Deni, G. Danelli, B. Borghi, G. Fanelli. (2000) Combined sciatic-femoral nerve block with 0.75% ropivacaine: effects of adding a systemically inactive dose of fentanyl. European Journal of Anaesthesiology 17:6, 348-353
CrossRef79
T. Tammisto, CH. Tammisto. (2000) Injection of morphine loco dolenti recommended as early as 1876. Acta Anaesthesiologica Scandinavica 44:5, 520-523
CrossRef80
Gillian R. Hamilton, Thomas F. BAskett. (2000) In the arms of morpheus: the development of morphine for postoperative pain relief. Canadian Journal of Anesthesia/Journal canadien d'anesthésie 47:4, 367-374
CrossRef81
Niall M. Graham, Michael D.G. Shanahan, Pat Barry, Sabine Burgert, Imitayaz Talkhani. (2000) Postoperative analgesia after arthroscopic knee surgery: A randomized, prospective, double-blind study of intravenous regional analgesia versus intra-articular analgesia. Arthroscopy: The Journal of Arthroscopic & Related Surgery 16:1, 64-66
CrossRef82
Sveinbjörn Brandsson, Jon Karlsson, Per Morberg, Bengt Rydgren, Bengt I Eriksson, Thomas Hedner. (2000) Intraarticular morphine after arthroscopic ACL reconstruction: A double-blind placebo-controlled study of 40 patients. Acta Orthopaedica 71:3, 280-285
CrossRef83
Judith Walker, Gwénaëlle Catheline, Gisèle Guilbaud, Valérie Kayser. (1999) Lack of cross-tolerance between the antinociceptive effects of systemic morphine and asimadoline, a peripherally-selective κ-opioid agonist, in CCI-neuropathic rats. Pain 83:3, 509-516
CrossRef84
Serge Perrot, Gisèle Guilbaud, Valérie Kayser. (1999) Effects of intraplantar morphine on paw edema and pain-related behaviour in a rat model of repeated acute inflammation. PAIN 83:2, 249-257
CrossRef85
Michael Schäfer. (1999) Peripheral opioid analgesia: from experimental to clinical studies. Current Opinion in Anaesthesiology 12:5, 603-607
CrossRef86
Vita Varkel, Gershon Volpin, Bruce Ben-David, Rayek Said, Bernard Grimberg, Kurt Simon, Michael Soudry. (1999) Intraarticular fentanyl compared with morphine for pain relief following arthroscopic knee surgery. Canadian Journal of Anesthesia/Journal canadien d'anesthésie 46:9, 867-871
CrossRef87
Helen L. Keates, Tess Cramond, Maree T. Smith. (1999) Intraarticular and Periarticular Opioid Binding in Inflamed Tissue in Experimental Canine Arthritis. Anesthesia & Analgesia 89:2, 409-415
CrossRef88
Sallyann T. Colbert, Emer Curran, Deirdre M. O’Hanlon, Ray Moran, Maire McCarroll. (1999) Intra-articular tenoxicam improves postoperative analgesia in knee arthroscopy. Canadian Journal of Anesthesia/Journal canadien d'anesthésie 46:7, 653-657
CrossRef89
Massimiliano M. Corsi, Alessandro Fulgenzi, Mario Tiengo, Giulio Pravettoni, Gianfranco Gaja, Maria Elena Ferrero. (1999) Effect of somatostatin on β-endorphin release in rat experimental chronic inflammation. Life Sciences 64:24, 2247-2254
CrossRef90
Alan A. Finegold, Andrew J. Mannes, Michael J. Iadarola. (1999) A Paracrine Paradigm for in Vivo Gene Therapy in the Central Nervous System: Treatment of Chronic Pain. Human Gene Therapy 10:7, 1251-1257
CrossRef91
Doris Tong, Frances Chung. (1999) POSTOPERATIVE PAIN CONTROL IN AMBULATORY SURGERY. Surgical Clinics of North America 79:2, 401-430
CrossRef92
Guo-Xi Xie, Thomas Meuser, Christian Pietruck, Manohar Sharma, Pamela Pierce Palmer. (1999) Presence of opioid receptor-like (ORL1) receptor mRNA splice variants in peripheral sensory and sympathetic neuronal ganglia. Life Sciences 64:22, 2029-2037
CrossRef93
Anders Söderlund, Lars O. Boreus, Lars Westman, Björn Engström, Anders Valentin, Anders Ekblom. (1999) A comparison of 50, 100 and 200 mg of intra-articular pethidine during knee joint surgery, a controlled study with evidence for local demethylation to norpethidine. Pain 80:1-2, 229-238
CrossRef94
Ma ̃lgorzata Krajnik, Zbigniew Zylicz, Ilora Finlay, Jacek Łuczak, Adriaan A. van Sorge. (1999) Potential uses of topical opioids in palliative care – report of 6 cases. Pain 80:1-2, 121-125
CrossRef95
Larry W. Moreland, E. William St. Clair. (1999) THE USE OF ANALGESICS IN THE MANAGEMENT OF PAIN IN RHEUMATIC DISEASES. Rheumatic Disease Clinics of North America 25:1, 153-191
CrossRef96
Marco Pappagallo. (1999) AGGRESSIVE PHARMACOLOGIC TREATMENT OF PAIN. Rheumatic Disease Clinics of North America 25:1, 193-213
CrossRef97
Natsuko Nozaki-Taguchi, Tony L. Yaksh. (1999) Characterization of the Antihyperalgesic Action of a Novel Peripheral Mu-opioid Receptor Agonist-Loperamide. Anesthesiology 90:1, 225-234
CrossRef98
Harkins, Tobin. (1999) Lack of local anaesthetic efficacy of fentanyl in the abaxial sesamoid block model. Journal of Veterinary Pharmacology and Therapeutics 22:1, 52-55
CrossRef99
Michael Rorarius, Pentti Suominen, Gerhard Baer, Paula Pajunen, Risto Tuimala, Pekka Laippala. (1999) Peripherally administered sufentanil inhibits pain perception after postpartum tubal ligation. Pain 79:1, 83-88
CrossRef100
Wolfgang Koppert, Rudolf Likar, Gerd Geisslinger, Susanne Zeck, Martin Schmelz, Reinhard Sittl. (1999) Peripheral Antihyperalgesic Effect of Morphine to Heat, but Not Mechanical, Stimulation in Healthy Volunteers after Ultraviolet-B Irradiation. Anesthesia & Analgesia 88:1, 117-122
CrossRef101
Daniel P. Moore, Rakesh Parikh, Sanford H. Vernick, Gregory F. Petroski, William H. Pryor, Steven C. Kazmierczak. (1998) Topical morphine in a canine model: A pilot study. Archives of Physical Medicine and Rehabilitation 79:9, 1034-1037
CrossRef102
Klaus A. Otto, Charles E. Short. (1998) Pharmaceutical control of pain in large animals. Applied Animal Behaviour Science 59:1-3, 157-169
CrossRef103
R Likar, R Sittl, K Gragger, W Pipam, H Blatnig, C Breschan, H.V Schalk, C Stein, M Schäfer. (1998) Peripheral morphine analgesia in dental surgery. Pain 76:1-2, 145-150
CrossRef104
Jon D Levine. (1998) New Directions in Pain Research: Molecules to Maladies. Neuron 20:4, 649-654
CrossRef105
Lin Cheng Yang, Liang-Mei Chen, Ching-Jen Wang, Hartmut Buerkle. (1998) Postoperative Analgesia by Intra-articular Neostigmine in Patients Undergoing Knee Arthroscopy. Anesthesiology 88:2, 334-339
CrossRef106
Scott S. Reuben, Robert B. Steinberg, Melvin A. Cohen, Prasad A. Kilaru, Charles S. Gibson. (1998) Intraarticular Morphine in the Multimodal Analgesic Management of Postoperative Pain After Ambulatory Anterior Cruciate Ligament Repair. Anesthesia & Analgesia 86:2, 374-378
CrossRef107
L MULLER, E VIEL, E VEYRAT, J ELEDJAM. (1998) Analgésie postopératoire par voie locorégionale chez l'adulte: techniques perimédullaires et périphériques. Indications, effets indésirables et surveillance. Annales Françaises d’Anesthésie et de Réanimation 17:6, 599-612
CrossRef108
X CAPDEVILA, P BIBOULET, Y BARTHELET. (1998) Analgésie postopératoire. Spécificités du sujet âgé. Annales Françaises d’Anesthésie et de Réanimation 17:6, 642-648
CrossRef109
B. Everts, B.W. Karlson, J. Herlitz, T. Hedner. (1998) Morphine use and pharmacokinetics in patients with chest pain due to suspected or definite acute myocardial infarction. European Journal of Pain 2:2, 115-125
CrossRef110
(1997) Pain management. Acta Anaesthesiologica Scandinavica 41, 180-190
CrossRef111
Per H. Rosenberg. (1997) Use of nerve block techniques for postoperative analgesia. Journal of Anesthesia 11:4, 292-299
CrossRef112
Marianne Eriksson-Mjöberg, Marianne Kristiansson, Kjell Carlström, Anders Ölund, Jan Eklund. (1997) Infiltration of morphine into an abdominal wound; effects on pain relief and endocrine/immune response. Pain 73:3, 355-360
CrossRef113
Massimiliano M. Corsi, Chiara Ticozzi, Carmela Netti, Alessandro Fulgenzi, Mario Tiengo, Gianfranco Gaja, Francesca Guidobono, Maria Elena Ferrero. (1997) The Effect of Somatostatin on Experimental Inflammation in Rats. Anesthesia & Analgesia 85:5, 1112-1115
CrossRef114
Martin D. Richardson, Andrew R. Bjorksten, John A.L. Hart, Keith McCullough. (1997) The efficacy of intra-articular morphine for postoperative knee arthroscopy analgesia. Arthroscopy: The Journal of Arthroscopic & Related Surgery 13:5, 584-589
CrossRef115
N. RAWAL, J. HYLANDER, R-A. NYDAHL, I. OLOFSSON, A. GUPTA. (1997) Survey of postoperative analgesia following ambulatory surgery. Acta Anaesthesiologica Scandinavica 41:8, 1017-1022
CrossRef116
Burt Sharp, Tony Yakshz. (1997) Pain killers of the immune system. Nature Medicine 3:8, 831-832
CrossRef117
Richard E Coggeshall, Shengtai Zhou, Susan M Carlton. (1997) Opioid receptors on peripheral sensory axons. Brain Research 764:1-2, 126-132
CrossRef118
D MAUERHAN, M CAMPBELL, J MILLER, J MOKRIS, A GREGORY, G KIEBZAK. (1997) Intra-articular morphine and/or bupivacaine in the management of pain after total knee arthroplasty1. The Journal of Arthroplasty 12:5, 546-552
CrossRef119
R. Likar, M. Schafer, F. Paulak, R. Sittl, W. Pipam, H. Schalk, D. Geissler, G. Bernatzky. (1997) Intraarticular Morphine Analgesia in Chronic Pain Patients with Osteoarthritis. Anesthesia & Analgesia 84:6, 1313-1317
CrossRef120
R COGGESHALL, S CARLTON. (1997) Receptor localization in the mammalian dorsal horn and primary afferent neurons. Brain Research Reviews 24:1, 28-66
CrossRef121
Lars Westman, Anders Valentin, Björn Engström, Anders Ekblom. (1997) Local anesthesia for arthroscopic surgery of the ankle using pethidine or prilocaine. Arthroscopy: The Journal of Arthroscopic & Related Surgery 13:3, 307-312
CrossRef122
Peter G. Atanassoff, Sorin J. Brull, Yevgeniy Printsev, David G. Silverman. (1997) The Effect of Intradermal Administration of Lidocaine and Morphine on the Response to Thermal Stimulation. Anesthesia & Analgesia 84:6, 1340-1343
CrossRef123
Eija Kalso, Martin R Tramèr, Dawn Carroll, Henry J McQuay, R.Andrew Moore. (1997) Pain relief from intra-articular morphine after knee surgery: a qualitative systematic review. Pain 71:2, 127-134
CrossRef124
Anne Whitford, M. Healy, Girish P. Joshi, S. M. McCarroll, Timothy M. OʼBrien. (1997) The Effect of Tourniquet Release Time on the Analgesic Efficacy of Intraarticular Morphine After Arthroscopic Knee Surgery. Anesthesia & Analgesia 84:4, 791-793
CrossRef125
M. MCSWINEY, J. COOPER, M. CAMPBELL. (1997) Intravenous regional analgesia using morphine. The effect on postoperative pain following total knee arthroplasty. Acta Anaesthesiologica Scandinavica 41:3, 345-347
CrossRef126
T. L. YAKSH. (1997) Pharmacology and mechanisms of opioid analgesic activity. Acta Anaesthesiologica Scandinavica 41:1, 94-111
CrossRef127
A. SODERLUND, L. WESTMAN, H. ERSMARK, E. ERIKSSON, A. VALENTIN, A. EKBLOM. (1997) Analgesia following arthroscopy - a comparison of intra-articular morphine, pethidine and fentanyl. Acta Anaesthesiologica Scandinavica 41:1, 6-11
CrossRef128
Sveinbjörn Brandsson, Bengt Rydgren, Thomas Hedner, Olof Lundin, Leif Sward, Jon Karlsson. (1996) Postoperative analgesic effects of an external cooling system and intra-articular bupivacaine/morphine after arthroscopic cruciate ligament surgery. Knee Surgery, Sports Traumatology, Arthroscopy 4:4, 200-205
CrossRef129
L Westman. (1996) A 3-day postoperative study related to pain, nausea, vomiting and tiredness in patients scheduled for day surgery. Ambulatory Surgery 4:2, 61-66
CrossRef130
M. Elhakim, A. Fathy, M. Elkott, M. M. Said. (1996) Intra-articular tenoxicam relieves post-arthroscopy pain. Acta Anaesthesiologica Scandinavica 40:10, 1223-1226
CrossRef131
Hiroshi Nagasaka, Hamdy Awad, Tony L. Yaksh. (1996) Peripheral and Spinal Actions of Opioids in the Blockade of the Autonomic Response Evoked by Compression of the Inflamed Knee Joint. Anesthesiology 85:4, 808-816
CrossRef132
I. J. WRENCH, P. TAYLOR, G. J. HOBBS. (1996) Lack of efficacy of intra-articular opioids for analgesia after day-case arthroscopy. Anaesthesia 51:10, 920-922
CrossRef133
B. Ben-David, R. A. Moscona, S. Stahl. (1996) The combination of morphine with local anaesthetic in rhinoplasty - no evidence of a peripheral morphine effect. Acta Anaesthesiologica Scandinavica 40:8, 892-897
CrossRef134
D. Bouhassire, N. Attal. (1996) Actualités de la douleur le point de vue de deux neurologues. Douleur et Analgésie 9:3, 73-86
CrossRef135
O. Christensen, P. Christensen, C. Sonnenschein, P. R. Nielsen, S. Jacobsen. (1996) Analgesic effect of intraarticular morphine. A controlled, randomised and double-blind study. Acta Anaesthesiologica Scandinavica 40:7, 842-846
CrossRef136
M. Raekallio, Polly M. Taylor, C. B. Johnson, R-M. Tulamo, M. Ruprah. (1996) The disposition and local effects of intra-articular morphine in normal ponies. Veterinary Anaesthesia and Analgesia 23:1, 23-26
CrossRef137
L WESTMAN. (1996) A follow-up study of the postoperative period at the hospital in patients scheduled for one-day surgery. Ambulatory Surgery 4:1, 5-9
CrossRef138
V. Aasbø, J. C. Raeeder, B. Grøgaard, O. Røise. (1996) No additional analgesic effect of intra-articular morphine or bupivacaine compared with placebo after elective knee arthroscopy. Acta Anaesthesiologica Scandinavica 40:5, 585-588
CrossRef139
M. Gentili, A. Juhel, F. Bonnet. (1996) Peripheral analgesic effect of intra-articular clonidine. Pain 64:3, 593-596
CrossRef140
JILL L. SAMMARCO, MICHAEL G. CONZEMIUS, SANDRA Z. PERKOWSKI, M. JOY WEINSTEIN, THOMAS P. GREGOR, GAIL K. SMITH. (1996) Postoperative Analgesia for Stifle Surgery: A Comparison of Intra-articular Bupivacaine, Morphine, or Saline. Veterinary Surgery 25:1, 59-69
CrossRef141
THOMAS K. DAY, WILLIAM T. PEPPER, TODD A. TOBIAS, MICHAEL F. FLYNN, KEVIN M. CLARKE. (1995) Comparison of Intra-articular and Epidural Morphine for Analgesia Following Stifle Arthrotomy in Dogs. Veterinary Surgery 24:6, 522-530
CrossRef142
Ian N. Back, Ilora Finlay. (1995) Analgesic effect of topical opioids on painful skin ulcers. Journal of Pain and Symptom Management 10:7, 493
CrossRef143
Barbara S. Levy, Randall Carpenter. (1995) Perioperative pain management. The Journal of the American Association of Gynecologic Laparoscopists 2:4, 381-387
CrossRef144
Paul AJ Hardy. (1995) Pain management in old age. Reviews in Clinical Gerontology 5:03, 259
CrossRef145
Epstein, Franklin H., , Stein, Christoph, . (1995) The Control of Pain in Peripheral Tissue by Opioids. New England Journal of Medicine 332:25, 1685-1690
Full Text146
Scott S. Reuben, Neil Roy Connelly. (1995) Postoperative Analgesia for Outpatient Arthroscopic Knee Surgery with Intraarticular Bupivacaine and Ketorolac. Anesthesia & Analgesia 80:6, 1154-1157
CrossRef147
K SCHEPELMANN, K MCBLINGER, H SCHAIBLE, R SCHMIDT. (1995) The opioid antagonist naloxone does not alter discharges of nociceptive afferents from the acutely inflamed knee joint of the cat. Neuroscience Letters 187:3, 212-214
CrossRef148
J. Karlsson, B. Rydgren, B. Eriksson, U. Järvholm, O. Lundin, L. Swärd, T. Hedner. (1995) Postoperative analgesic effects of intra-articular bupivacaine and morphine after arthroscopic cruciate ligament surgery. Knee Surgery, Sports Traumatology, Arthroscopy 3:1, 55-59
CrossRef149
Hans Schulte-Steinberg, Ernst Weninger, Dominik Jokisch, Bernhard Hofstetter, Axel Misera, Volker Lange, Christoph Stein. (1995) Intraperitoneal Versus Interpleural Morphine or Bupivacaine for Pain after Laparoscopic Cholecystectomy. Anesthesiology 82:3, 634-640
CrossRef150
Christoph Stein, Michael Schäfer, Ahmed H. S. Hassan. (1995) Peripheral Opioid Receptors. Annals of Medicine 27:2, 219-221
CrossRef151
M. Cardosa, G.E. Rudkin, G.A. Osborne. (1994) Outcome from day-case knee arthroscopy in a major teaching hospital. Arthroscopy: The Journal of Arthroscopic & Related Surgery 10:6, 624-629
CrossRef152
Agnieszka Bałkowiec, Krzysztof Kukuła, Paweł Szulczyk. (1994) Influence of morphine on the activity of low-threshold visceral mechanoreceptors in cats with acute pericarditis. Pain 59:2, 251-259
CrossRef153
A JEANJEAN, J MALOTEAUX, P LADURON. (1994) IL-1β-like Freund's adjuvant enhances axonal transport of opiate receptors in sensory neurons. Neuroscience Letters 177:1-2, 75-78
CrossRef154
YRJÖ T. Konttinen, Pertti Kemppinen, Margaretha Segerberg, Mika Hukkanen, Richard Rees, Seppo Santavirta, Timo Sorsa, Antti Pertovaara, Julia M. Polak. (1994) Peripheral and spinal neural mechanisms in arthritis, with particular reference to treatment of inflammation and pain. Arthritis & Rheumatism 37:7, 965-982
CrossRef155
Haim Rosen, Zvi Bar-Shavit. (1994) Dual role of osteoblastic proenkephalin derived peptides in skeletal tissues. Journal of Cellular Biochemistry 55:3, 334-339
CrossRef156
L. NIEMI, M. PITKÄNEN, M. TUOMINEN, J.-M. BJÖRKENHEIM, P. H. ROSENBERG. (1994) Intraarticular morphine for pain relief after knee arthroscopy performed under regional anaesthesia. Acta Anaesthesiologica Scandinavica 38:4, 402-405
CrossRef157
Barry P. Boden, Steven Fassler, Suzane Cooper, Paul A. Marchetto, Raymond A. Moyer. (1994) Analgesic effect of intraarticular morphine, bupivacaine, and morphine/bupivacaine after arthroscopic knee surgery. Arthroscopy: The Journal of Arthroscopic & Related Surgery 10:1, 104-107
CrossRef158
I. Maszczynska, M. Mikaszewska, D. Kosson, D.B. Carr, S.K. Szyfelbein, A.W. Lipkowski. (1994) Interaction between morphine and opioid peptides after S.C. administration. Regulatory Peptides 53, S243-S244
CrossRef159
Joergen Dalsgaard, Sven Felsby, Palle Juelsgaard, Johnny Froekjaer. (1994) Low-dose intra-articular morphine analgesia in day case knee arthroscopy: A randomized double-blinded prospective study. Pain 56:2, 151-154
CrossRef160
J. B. DAHL, S. MØINICHE, H. KEHLET. (1994) Wound infiltration with local anaesthetics for postoperative pain relief. Acta Anaesthesiologica Scandinavica 38:1, 7-14
CrossRef161
Agnes Langlade, Daniel B. Carr, Alain Serrie, Brendan S. Silbert, Stanislaw K. Szyfelbein, Andrzej W. Lipkowski. (1994) Enhanced potency of intravenous, but not intrathecal, morphine and morphine-6-glucuronide after burn trauma. Life Sciences 54:22, 1699-1709
CrossRef162
PH. Rosenberg. (1993) Local anaesthesia techniques. Acta Anaesthesiologica Scandinavica 37, 132-134
CrossRef163
Hans-Georg Schaible, Blair D. Grubb. (1993) Afferent and spinal mechanisms of joint pain. Pain 55:1, 5-54
CrossRef164
S. MØINICHE, J. B. DAHL, H. KEHLET. (1993) Peripheral antinociceptive effects of morphine after burn injury. Acta Anaesthesiologica Scandinavica 37:7, 710-712
CrossRef165
Athanassios Giannis, Thomas Kolter. (1993) Peptidmimetica für Rezeptorliganden – Entdeckung, Entwicklung und medizinische Perspektiven. Angewandte Chemie 105:9, 1303-1326
CrossRef166
J. Jage. (1993) Perioperative Schmerztherapie beim Erwachsenen. Der Schmerz 7:3, 140-153
CrossRef167
H. W. Striebel, R. Schwagmeier, N. Boerger. (1993) Neue Applikationswege für Opioide. Der Schmerz 7:3, 131-139
CrossRef168
Athanassios Giannis, Thomas Kolter. (1993) Peptidomimetics for Receptor Ligands?Discovery, Development, and Medical Perspectives. Angewandte Chemie International Edition in English 32:9, 1244-1267
CrossRef169
C. Stein, A.H.S. Hassan, K. Lehrberger, C. Stein, J. Giefing, A. Yassouridis. (1993) Local analgesic effect of endogenous opioid peptides. The Lancet 342:8867, 321-324
CrossRef170
Sten Rasmussen, Søren Thomsen, Susanne Nørgaard Madsen, Per Joen Svabo Rasmussen, Ole Højgaard Simonsen. (1993) The clinical effect of naproxen sodium after arthroscopy of the knee: A randomized, double-blind, prospective study. Arthroscopy: The Journal of Arthroscopic & Related Surgery 9:4, 375-380
CrossRef171
H. W. Striebel, J. Krämer, I. Luhmann, I. Rohierse-Hohler, A. Rieger. (1993) Pharmakokinetische Studie zur intranasalen Gabe von Fentanyl. Der Schmerz 7:2, 122-125
CrossRef172
P. J. ARMSTRONG, C. P. J. MORTON, A. F. NIMMO. (1993) Pethidine has a local anaesthetic action on peripheral nerves in vivo.. Anaesthesia 48:5, 382-386
CrossRef173
C. Stein. (1993) Periphere Opioidrezeptoren und ihre Bedeutung für die postoperative Schmerztherapie. Der Schmerz 7:1, 4-7
CrossRef174
Michael A. Ashby, Beverley G. Fleming, Mary Brooksbank, Bruce Rounsefell, William B. Runciman, Kate Jackson, Nell Muirden, Michael Smith. (1992) Description of a mechanistic approach to pain management in advanced cancer. Preliminary report. Pain 51:2, 153-161
CrossRef175
A. J. Lawrence, G. P. Joshi, A. Michalkiewiczi, W. P. Blunnie, D. C. Moriarty. (1992) Evidence for analgesia mediated by peripheral opioid receptors in inflamed synovial tissue. European Journal of Clinical Pharmacology 43:4, 351-355
CrossRef176
M. T. PITKÄNEN, P. H. ROSENBERG, P. J. PERE, M. K. TUOMINEN, T. A. SEPPÄLÄ. (1992) Fentanyl-prilocaine mixture for intravenous regional anaesthesia in patients undergoing surgery. Anaesthesia 47:5, 395-398
CrossRef177
(1992) Analgesic Effect of Intraarticular Morphine after Knee Surgery. New England Journal of Medicine 326:13, 894-895
Full Text178
B. M. Ure, H. Troidl, E. Neugehauer, M. Edelmann. (1992) Akuter schmerz in der chirurgie die bedeutung eines vernachl
ssigten problems. Langenbecks Archiv f
CrossRef179
Basbaum, Allan I.Levine, Jon D.. (1991) Opiate Analgesia. New England Journal of Medicine 325:16, 1168-1169
Full Text
- Letters
