Table 13a: Postoperative intra-articular LA + morphine versus placebo: study details and qualitative outcomes
Study | n treatment/ control | Comparison | Supplemental analgesic | VAS scores and type of pain, where specified | Time to first analgesic request | Use of supplemental analgesic | Other important outcomes |
(LoE 1) | 28/27 | After wound closure but before tourniquet release, 30 ml intra-articular injection containing: bupivacaine (50 mg) + morphine sulphate (5 mg) (BupMor) vs. saline (Pb) | Postop: PCA-morphine sulphate for 24 h | BupMor superior at 4 h, (p<0.05), but NS at 2, 6, 24 or 48 h | __ | NS during 1st 24 h postop | __ |
117/97 | Intra-articular injection after skin closure: 1 ml morphine (10 mg) + 9 ml bupivacaine (2.5 mg/ml) (BupMor) vs. 10 ml saline (Pb) | Postop analgesia: ketorolac, pethidine, morphine (usually by PCA), for 24 h | NS over 24 h postop (McGill-Melzack 0–5 scale) | __ | Ketorolac and pethidine consumption at 24 h: NS; morphine consumption at 24 h: Pb superior (p=0.0242) | Hospital stay Length of hospital stay: NS | |
(LoE 2) | Osteo-arthritis: 12/10 | Postop intra-articular morphine (5 mg) in 30 ml 0.25% bupivacaine with 1:200,000 epinephrine (BupMor) vs. 30 ml saline with 1:200,000 epinephrine (Pb) | Postop: PCA morphine sulphate for 48 h | BupMor superior at 2, 4, 6 and 24 h postop (p<0.05, in all cases), but NS at 48 h; VAS rated by staff | BupMor superior (p<0.01) | Total 48 h morphine requirement: BupMor superior (p<0.01) | Functional outcomes Range of movement at discharge: BupMor superior (p<0.05) Complications Pruritus, respiratory depression, urinary retention, rash: NS |