Efficacy and Safety of Genicular Nerve Block with Intraarticular Morphine in Knee Arthroscopic Procedures under Spinal Anaesthesia

Nasarul Haque Khadem; Kazi Mahzabin Arin; Farzana Zaman Popy; Md. Ashfak Ahmad; Yesmin Akter; Sayeda Sabrina Mumu; Md Mostafa Kamal; Mohammad Shafiqul Islam; AKM Akhtaruzzaman

doi:10.62848/bjpain.v6i1.7453

Authors

Nasarul Haque Khadem Resident, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University, Dhaka. https://orcid.org/0009-0003-3409-2396
Kazi Mahzabin Arin Assistant Professor, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University, Dhaka. https://orcid.org/0009-0004-0064-3847
Farzana Zaman Popy Resident, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University, Dhaka. https://orcid.org/0009-0002-8345-7534
Md. Ashfak Ahmad Resident, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University, Dhaka.
Yesmin Akter Resident, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University, Dhaka. https://orcid.org/0009-0000-8708-1007
Sayeda Sabrina Mumu Medical Officer, BLCS Hospital, Dhaka.
Md Mostafa Kamal Assistant Professor (OSD, DGHS) & Advanced Clinical Fellow, Pain Medicine, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University, Dhaka https://orcid.org/0000-0002-4665-1904
Mohammad Shafiqul Islam Professor, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University, Dhaka. https://orcid.org/0000-0003-3443-7828
AKM Akhtaruzzaman Professor, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University, Dhaka. https://orcid.org/0000-0002-2427-1863

DOI:

https://doi.org/10.62848/bjpain.v6i1.7453

Keywords:

Spinal anaesthesia, Genicular nerve block, Intra-articular morphine, Knee arthroscopy, Postoperative analgesia

Abstract

Background: Knee arthroscopy, a minimally invasive procedure, often results in significant postoperative pain, which may delay recovery. Traditional approaches, including non-steroidal anti-inflammatory drugs and opioids, can result in various adverse effects and often do not provide sufficient analgesia. The genicular nerve block (GNB) may be a preferable alternative for pain relief, as it specifically targets the sensory nerves surrounding the knee. However, because the duration of action of local anesthetics is brief, they may not provide lasting analgesia. Therefore, the addition of intra-articular morphine in the knee joint can extend the analgesic effects, ensuring optimal pain relief. This study aims to assess the efficacy and safety of the combination of genicular nerve block (GNB) and intraarticular morphine compared to genicular nerve block alone for postoperative pain management in knee arthroscopic procedures.

Methods: This was a double-blind, randomized controlled trial in which patients were enrolled after obtaining informed written consent, who were scheduled for knee arthroscopic surgery under spinal anaesthesia at Bangladesh Medical University. Participants were randomized into two groups: Control group (Group GN) received ultrasound-guided genicular nerve block (GNB) with intraarticular normal saline and intervention group (Group GM) received ultrasound-guided genicular nerve block with intraarticular morphine. Postoperative pain scores were assessed by Numeric Rating Scale (NRS) scoring system immediately at recovery, every hourly up to 6 hours followed by at 12 hours and 24 hours. Total opioid consumption (mg) in 24 hours, time to first rescue analgesia (hours), incidence of postoperative nausea and vomiting (PONV), and haemodynamic parameters (systolic blood pressure,diastolic blood pressure,mean arterial pressure in mmHg and heart rate in beat/min) were assessed for up to 24 hours.

Results: A total of 30 patients were enrolled in this study. They were randomized into 2 groups (15 in each group). Baseline demographic and clinical parameters were comparable between groups. Group GM showed significantly lower total morphine consumption (mg) in 24 hours (4.16 ± 0.88) compared to group GN (5.93 ± 1.79) , with a p value of 0.02. The time to first analgesic request (hours) was significantly longer in Group GM (5.91 ± 1.48) compared to Group GN (4.2 ± 1.87) with a p value of 0.03. No significant differences were found in the incidence of postoperative nausea vomiting (p = 0.54).

Conclusions: Combining a genicular nerve block with intraarticular morphine is safe and effective for postoperative pain management after knee arthroscopy. This strategy prolongs analgesia and reduces total morphine consumption compared to the genicular nerve block alone.