Table 4.
Comparison of randomized controlled trials of intrathecal morphine and periarticular multimodal drug injection
| Study | Number | Followup time | Intervention | Regimen | Average pain score at 24 hours | Average pain score at 48 hours | Average drug consumption at 24 hours | Knee Society Score© | Flexion motion | Adverse effects | Conclusions |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Cole et al. [6] | 34 | 24 hours | Spinal morphine vs placebo | 0.3 mg morphine | VAS movement 30 vs 50 |
NA | Morphine 20 mg vs 40 mg |
NA | NA | No difference in PONV & pruritus | Less pain & morphine consumption in first 24 hours after surgery |
| Hassett et al. [12] | 60 | 24 hours | 0.1 vs 0.2 vs 0.3 mg spinal morphine | 0.1, 0.2, 0.3 mg morphine | VAS 14 vs 11 vs 11 |
NA | Morphine 0.1 mg: 15 mg 0.2 mg: 5 mg 0.3 mg: 4 mg |
NA | NA | No differrence in PONV & pruritus | 0.1 mg spinal morphine had more pain & morphine consumption in first 24 hours after surgery |
| Busch et al. [3] | 64 | 3 months | PAI vs placebo | 400 mg ropivacaine, 30 mg ketorolac, 5 mg morphine, 0.6 mg epinephrine | VAS 45 vs 55 |
NA | Morphine 25 mg vs 45 mg |
KSS Preoperative 87 vs 89 Postoperative 12 weeks: 166 vs 161 WOMAC Preoperative 17 vs 16 Postoperative 12 weeks: 9 vs 9 |
NA | NA | Less pain in PACU & 4 hours after surgery; less morphine consumption in first 24 hours after surgery |
| Vendittoli et al. [25] | 42 | 5 days | Multiple dose PAI vs placebo | Intraoperative 275 mg ropivacaine, 30 mg ketorolac, 0.5 mg epinephrine POD1 (IAI) 150 mg ropivacaine |
VAS 20 vs 30 |
VAS 13 vs 18 |
Morphine 29 mg vs 50 mg |
NA | POD5 90° vs 94° |
Less PONV in PAI | Less pain & morphine consumption up to 48 hours after surgery |
| Essving et al. [9] | 50 | 3 months | Multiple dose PAI vs spinal morphine | Intraoperative Ropivacaine 400 mg, ketorolac 30 mg, epinephrine 0.5 mg POD1&2 (IAI) Ropivacaine 200 mg, ketorolac 30 mg, epinephrine 0.1 mg vs 0.1 mg spinal morphine |
VAS rest 5 vs 15 VAS flexion 25 vs 52 VAS walking 19 vs 58 |
VAS rest 5 vs 20 VAS flexion 30 vs 59 VAS walking 10 vs 39 |
Morphine 15 mg vs 30 mg |
OKS Preoperative 39 vs 38 Postoperative 12 weeks: 24 vs 24 |
Preoperative 110° vs 110° Postoperative 12 weeks: 100° vs 100° |
No difference in PONV & pruritus | Less pain & morphine consumption up to 48 hours after surgery |
| Current study | 59 | 3 months | PAI vs spinal morphine | 100 mg bupivacaine, 30 mg ketorolac, 5 mg morphine, 0.6 mg epinephrine vs 0.2 mg spinal morphine | VAS 47 vs 57 |
VAS 34 vs 36 |
Ketorolac 24 mg vs 30 mg |
Modified WOMAC Preoperative 43 vs 50 Postoperative 12 weeks: 9 vs 9 |
Preoperative 121° vs 127° Postoperative 12 weeks: 139° vs 140° |
Less PONV & pruritus in PAI | No difference if pain & ketorolac consumption during 48 hours after surgery; less adverse effects in PAI |
PAI = periarticular injection; IAI = intraarticular injection; POD = postoperative day; PONV = postoperative nausea and vomiting; PACU = postanesthetic care unit; KSS = The Knee Society Clinical Rating Score©; WOMAC™ = Western Ontario and McMaster Universities Osteoarthritis Index; OKS = Oxford Knee Score.