Table 14a: Postoperative intra-articular morphine + LA versus intra-articular LA alone: 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) | 25/25 | After wound closure, but before tourniquet release, 31 ml intra-articular injection containing: 0.5% bupivacaine (30 ml) + 1:200,000 epinephrine + 1 ml morphine (1 mg) (BupMor) vs. 0.5% bupivacaine (30 ml) + 1:200,000 epinephrine + 1 ml saline (Bup) | Postop: PCA morphine (1 mg dose, 6-min lockout) | NS at all time points (i.e. 1, 2, 4 or 24 h after arrival in PACU) | __ | NS over 24 h postop | Pain VRS scores: NS PONV NS Functional outcomes Range of motion: decreased in both groups, NS Complications Pruritus, urinary retention, somnolence: NS |
(LoE 1) | 28/24 | After wound closure, but before tourniquet release, 30 ml intra-articular injection containing: bupivacaine (50 mg) + morphine sulphate (5 mg) (BupMor) vs. bupivacaine (50 mg) (Bup) | Postop: PCA morphine sulphate (1 mg/ml, 5-min lockout) | NS at all time points (i.e. 2,4, 6, 24 or 48 h) | __ | NS during 1st 24 h postop | __ |
(LoE 1) | 117/114 | Intra-articular injection after skin closure: 1 ml morphine (10 mg) + 9 ml bupivacaine (2.5 mg/ml) (BupMor) vs. 10 ml bupivacaine (2.5 mg/ml) (Bup) | 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: Bup superior (p=0.0101) | Hospital stay |