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A Single-Dose Intra-Articular Morphine plus Bupivacaine versus Morphine Alone following Knee Arthroscopy: A Systematic Review and Meta-Analysis.

Xie DX, Zeng C, Wang YL, Li YS, Wei J, Li H, Yang T, Yang TB, Lei GH - PLoS ONE (2015)

Bottom Line: In addition, systematic review showed that intra-articular morphine plus bupivacaine would not increase the incidence of adverse effects compared with morphine alone.The present study suggested that the administration of single-dose intra-articular morphine plus bupivacaine provided better pain relief during the immediate period (0-2h), and lengthened the time interval before the first request for analgesic rescue without increasing the short-term side effects when compared with morphine alone.Level I, meta-analysis of Level I studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China.

ABSTRACT

Objectives: The purpose of this study was to compare the efficacy and safety of a single-dose intra-articular morphine plus bupivacaine versus morphine alone in patients undergoing arthroscopic knee surgery.

Methods: Randomized controlled trials comparing a combination of morphine and bupivacaine with morphine alone injected intra-articularly in the management of pain after knee arthrocopic surgery were retrieved (up to August 10, 2014) from MEDLINE, the Cochrane Library and Embase databases. The weighted mean difference (WMD), relative risk (RR) and their corresponding 95% confidence intervals (CIs) were calculated using RevMan statistical software.

Results: Thirteen randomized controlled trials were included. Statistically significant differences were observed with regard to the VAS values during the immediate period (0-2h) (WMD -1.16; 95% CI -2.01 to -0.31; p = 0.007) and the time to first request for rescue analgesia (WMD = 2.05; 95% CI 0.19 to 3.92; p = 0.03). However, there was no significant difference in the VAS pain score during the early period (2-6h) (WMD -0.36; 95% CI -1.13 to 0.41; p = 0.35), the late period (6-48h) (WMD 0.11; 95% CI -0.40 to 0.63; p = 0.67), and the number of patients requiring supplementary analgesia (RR = 0.78; 95% CI 0.57 to 1.05; p = 0.10). In addition, systematic review showed that intra-articular morphine plus bupivacaine would not increase the incidence of adverse effects compared with morphine alone.

Conclusion: The present study suggested that the administration of single-dose intra-articular morphine plus bupivacaine provided better pain relief during the immediate period (0-2h), and lengthened the time interval before the first request for analgesic rescue without increasing the short-term side effects when compared with morphine alone.

Level of evidence: Level I, meta-analysis of Level I studies.

No MeSH data available.


Related in: MedlinePlus

Funnel plot of meta-analysis: visual analogue scale score of postoperative pain intensity in the immediate period (0-2h).WMD, weighted mean difference.
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pone.0140512.g003: Funnel plot of meta-analysis: visual analogue scale score of postoperative pain intensity in the immediate period (0-2h).WMD, weighted mean difference.

Mentions: During the immediate period (0-2h), data provided by nine studies were pooled [5,13,16,21,22,24–26,31]. Overall, the combined group showed a statistically significant lower postoperative pain intensity compared with morphine group (WMD -1.16; 95% CI -2.01 to -0.31; p = 0.007), while significant heterogeneity was observed (I2 = 82%; p<0.00001) (Fig 2). Sensitivity analyses showed that the results were stable and reliable. The overall WMD did not change substantially when studies of poor methodological quality were excluded or other exclusions were applied; it ranged from -1.38 (95% CI -2.29 to -0.48; p = 0.003) to -1.05 (95% CI -2.00 to -0.10; p = 0.03) (Table 2). Substantial asymmetry was not identified in the funnel plot (Begg’s test, p = 0.348) (Fig 3). Of the other three studies whose data were not available for quantitative meta-analysis, two showed negative results and one showed positive result [23,27,32].


A Single-Dose Intra-Articular Morphine plus Bupivacaine versus Morphine Alone following Knee Arthroscopy: A Systematic Review and Meta-Analysis.

Xie DX, Zeng C, Wang YL, Li YS, Wei J, Li H, Yang T, Yang TB, Lei GH - PLoS ONE (2015)

Funnel plot of meta-analysis: visual analogue scale score of postoperative pain intensity in the immediate period (0-2h).WMD, weighted mean difference.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608597&req=5

pone.0140512.g003: Funnel plot of meta-analysis: visual analogue scale score of postoperative pain intensity in the immediate period (0-2h).WMD, weighted mean difference.
Mentions: During the immediate period (0-2h), data provided by nine studies were pooled [5,13,16,21,22,24–26,31]. Overall, the combined group showed a statistically significant lower postoperative pain intensity compared with morphine group (WMD -1.16; 95% CI -2.01 to -0.31; p = 0.007), while significant heterogeneity was observed (I2 = 82%; p<0.00001) (Fig 2). Sensitivity analyses showed that the results were stable and reliable. The overall WMD did not change substantially when studies of poor methodological quality were excluded or other exclusions were applied; it ranged from -1.38 (95% CI -2.29 to -0.48; p = 0.003) to -1.05 (95% CI -2.00 to -0.10; p = 0.03) (Table 2). Substantial asymmetry was not identified in the funnel plot (Begg’s test, p = 0.348) (Fig 3). Of the other three studies whose data were not available for quantitative meta-analysis, two showed negative results and one showed positive result [23,27,32].

Bottom Line: In addition, systematic review showed that intra-articular morphine plus bupivacaine would not increase the incidence of adverse effects compared with morphine alone.The present study suggested that the administration of single-dose intra-articular morphine plus bupivacaine provided better pain relief during the immediate period (0-2h), and lengthened the time interval before the first request for analgesic rescue without increasing the short-term side effects when compared with morphine alone.Level I, meta-analysis of Level I studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China.

ABSTRACT

Objectives: The purpose of this study was to compare the efficacy and safety of a single-dose intra-articular morphine plus bupivacaine versus morphine alone in patients undergoing arthroscopic knee surgery.

Methods: Randomized controlled trials comparing a combination of morphine and bupivacaine with morphine alone injected intra-articularly in the management of pain after knee arthrocopic surgery were retrieved (up to August 10, 2014) from MEDLINE, the Cochrane Library and Embase databases. The weighted mean difference (WMD), relative risk (RR) and their corresponding 95% confidence intervals (CIs) were calculated using RevMan statistical software.

Results: Thirteen randomized controlled trials were included. Statistically significant differences were observed with regard to the VAS values during the immediate period (0-2h) (WMD -1.16; 95% CI -2.01 to -0.31; p = 0.007) and the time to first request for rescue analgesia (WMD = 2.05; 95% CI 0.19 to 3.92; p = 0.03). However, there was no significant difference in the VAS pain score during the early period (2-6h) (WMD -0.36; 95% CI -1.13 to 0.41; p = 0.35), the late period (6-48h) (WMD 0.11; 95% CI -0.40 to 0.63; p = 0.67), and the number of patients requiring supplementary analgesia (RR = 0.78; 95% CI 0.57 to 1.05; p = 0.10). In addition, systematic review showed that intra-articular morphine plus bupivacaine would not increase the incidence of adverse effects compared with morphine alone.

Conclusion: The present study suggested that the administration of single-dose intra-articular morphine plus bupivacaine provided better pain relief during the immediate period (0-2h), and lengthened the time interval before the first request for analgesic rescue without increasing the short-term side effects when compared with morphine alone.

Level of evidence: Level I, meta-analysis of Level I studies.

No MeSH data available.


Related in: MedlinePlus