Table 13b: Intra-/postoperative intra-articular morphine versus placebo or no treatment (systemic analgesia available to all patients): 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) | 10/10 | 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 | PONV NS Complications Dizziness, pruritus: NS |
(LoE 1) | 26/27 | 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 | __ |
(LoE 1) | 109/97 | 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 |