Table 13a: Postoperative intra-articular LA + morphine versus placebo

Table 13a: Postoperative intra-articular LA + morphine versus placebo: study details and qualitative outcomes



n treatment/





VAS scores and type of pain, where specified

Time to first analgesic request

Use of supplemental analgesic

Other important outcomes

Mauerhan 1997

(LoE 1)


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


Ritter 1999 

(LoE 1)


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

Tanaka 2001

(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)


Pruritus, respiratory depression, urinary retention, rash: NS