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Local Analgesia without Anesthesia Using Peripheral Perineural Morphine Injections

Anesthesiology and Pain Units, Baptist Memorial Hospital, the Anesthesiology Department Pain Clinic, The University of Tennessee Center for the Health Sciences, Memphis, and the Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN.

Abstract

Twenty-five patients with chronic pain were treated with nerve blocks. They were divided into two groups, A and B, according to the volume of local anesthetic required for surgical anesthesia by standard nerve block techniques. The 16 patients in group A had pain in the distribution of small nerves, which could be blocked with 5 ml or less. They were blocked in a random, double-blind crossover fashion using 0.5% bupivacaine or 0.02% morphine. The nine patients in group B were injected simultaneously with saline, 30 ml perineurally and 1 ml intramuscularly. Morphine (6 mg) was added, in a random, double-blind fashion, to one of the injections. A second pair of injections was subsequently done, using morphine by the alternative route. Perineural morphine provided statistically longer lasting pain relief than did either intramuscular morphine or perineural bupivacaine.

Key Words: PAIN—chronic. • ANALGESICS—morphine. • ANESTHETICS, LOCAL—bupivacaine.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999