Table 13c: Postoperative intra-articular LA bolus 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) | 27/27 | 30 ml saline before incision and 0.5% bupivacaine (30 ml) + 1:200,000 epinephrine in saline after wound closure (Bup) vs. 30 ml saline for both injections (Pb) | Postop: PCA-morphine for 24 h | NS at all time points (i.e. at 1, 2, 4 and 24 h after arrival in PACU) | __ | Morphine consumption in 1st 24 h: Bup superior (p=0.006) | Pain VRS scores: NS PONV NS Functional outcomes Range of motion at discharge: Bup superior (p=0.009) Complications Side-effects (urinary retention, pruritus, somnolence): NS |
(LoE 1) | 24/27 | After wound closure but before tourniquet release, 30 ml intra-articular injection containing: 50 mg bupivacaine (Bup) vs. saline (Pb) | Postop: PCA-morphine sulphate for 24 h | Bup superior at 4 h (p<0.05), but NS at 2, 6, 24 or 48 h | __ | NS during 1st 24 h postop | __ |
(LoE 1) | 114/97 | Intra-articular injection after skin closure: 10 ml bupivacaine (2.5 mg/ml) (Bup) 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, pethidine and morphine consumption at 24 h: NS | Hospital stay Length of hospital stay: NS |