Table 13b: Intra-/postoperative intra-articular morphine vs. placebo or no treatment

Table 13b: Intra-/postoperative intra-articular morphine versus placebo or no treatment (systemic analgesia available to all patients): study details and qualitative outcomes


n treatment/



Supplemental analgesic

VAS scores and type of pain, where specified

Time to first analgesic request

Use of supplemental analgesic

Other important outcomes

Klasen 1999

(LoE 1)


Intra-op intra-articular morphine (1 mg) in 20 ml saline + PCA-morphine IV (IntMor) vs. PCA-morphine IV only (Cont)

Not reported

NS over 24 h postop


Morphine consumption: NS over 24 h postop




Dizziness, pruritus: NS

Mauerhan 1997

(LoE 1)


After wound closure but before tourniquet release, 30 ml intra-articular injection containing: 5 mg morphine sulphate (IntMor) vs. saline (Pb)

Postop: PCA-morphine sulphate for 24 h

IntMor 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 saline (IntMor) 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=0.0264)

Hospital stay

Length of hospital stay: NS