Single-dose intra-articular bupivacaine plus morphine after knee arthroscopic surgery: a meta-analysis of randomised placebo-controlled studies

BMJ Open. 2015 Jun 15;5(6):e006815. doi: 10.1136/bmjopen-2014-006815.

Abstract

Objectives: To evaluate the efficacy and safety of single-dose intra-articular bupivacaine plus morphine after knee arthroscopic surgery.

Design: Meta-analysis.

Data sources and study eligibility criteria: A comprehensive literature search, using Medline (1966-2014), the Cochrane Central Register of Controlled Trials and Embase databases, was conducted to identify randomised placebo-controlled trials that used a combination of single-dose intra-articular bupivacaine and morphine for postoperative pain relief.

Results: 12 articles were included in this meta-analysis. The mean visual analogue scale (VAS) scores of the bupivacaine plus morphine group were significantly lower than those of the placebo group (weighted mean difference (WMD) -1.75; 95% CI -2.16 to -1.33; p<0.001). The VAS scores at the last follow-up time point (last VAS scores) of the bupivacaine plus morphine group were also significantly lower than those of the placebo group (WMD -1.46; 95% CI -1.63 to -1.29; p<0.001). The number of patients requiring supplementary analgesia was also significantly reduced (RR 0.60; 95% CI 0.39 to 0.93; p=0.02), while there was no significant difference in the time to first analgesic request (WMD 3.46; 95% CI -1.81 to 8.72; p=0.20) or short-term side effects (RR 1.67; 95% CI 0.65 to 4.26; p=0.29).

Conclusions: The administration of single-dose intra-articular bupivacaine plus morphine after knee arthroscopic surgery is effective for pain relief, and its short-term side effects remain similar to saline placebo.

Keywords: ANAESTHETICS; STATISTICS & RESEARCH METHODS.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analgesia / methods
  • Analgesics, Opioid / therapeutic use
  • Anesthetics, Local / therapeutic use
  • Arthroscopy / adverse effects*
  • Bupivacaine / therapeutic use*
  • Humans
  • Knee / pathology
  • Knee / surgery*
  • Knee Joint / pathology
  • Knee Joint / surgery*
  • Morphine / therapeutic use*
  • Musculoskeletal Pain / etiology
  • Musculoskeletal Pain / prevention & control*
  • Pain, Postoperative / prevention & control*
  • Treatment Outcome

Substances

  • Analgesics, Opioid
  • Anesthetics, Local
  • Morphine
  • Bupivacaine

Associated data

  • Dryad/10.5061/dryad.RQ38C