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









































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


Klasen 1999


(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


Mauerhan 1997


(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


__


Ritter 1999


(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