Table 14c: Postoperative intra-articular LA + morphine versus morphine alone: study details and qualitative outcomes
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. 30 ml saline + 1:200,000 epinephrine + 1 ml (1 mg) morphine (Mor) | Postop: PCA-morphine for 24 h | NS at all time points (i.e. 1, 2, 4 or 24 h) | __ | NS over 24 h postop | Pain VRS scores: NS PONV NS Functional outcomes Range of motion: NS Complications Pruritus, urinary retention, somnolence: NS |
(LoE 1) | 28/26 | After wound closure but before tourniquet release, 30 ml intra-articular injection containing: 50 mg bupivacaine + 5 mg morphine (BupMor) vs. morphine (5 mg) (Mor) | Postop: PCA-morphine sulphate for 24 h | NS at all time points (i.e. 2, 4, 6, 24 and 48 h) | __ | NS during 1st 24 h postop | __ |
(LoE 1) | 117/109 | Intra-articular injection after skin closure: 9 ml bupivacaine (2.5 mg/ml) + 1 ml morphine (10 mg) (BupMor) vs. 1ml morphine (10 mg) + 9 ml saline (Mor) | 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 |