Fulton 2000.

Methods	Randomised trial, parallel‐group design with 4 comparisons
Participants	130 patients. Femoral sheath removed by medical staff 4 to 6 hours after elective or urgent PCI. Manual compression. Median age 64.8 years. 72% males. 20% had previous experience of sheath removal.
Interventions	IV morphine 0.05 mg/kg or IV fentanyl 0.5 µg/kg or SC lignocaine 2% 5 ml (100 mg) or IV saline placebo Rescue analgesia (fentanyl) was made available to all groups
Outcomes	Pain score using VAS during sheath removal (10 minutes prior, 1 minute and 20 minutes after) Secondary outcomes: use of rescue analgesia; incidence of haematoma and vascular complications, vasovagal reactions, nausea and vomiting Pain scores from patients given analgesia (SC lignocaine, IV morphine, IV fentanyl) were not significantly different from pain scores in placebo group
Notes	Quality score 2/5
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Random allocation stated, sequence generation not reported
Allocation concealment (selection bias)	Unclear risk	Allocation concealment method not reported. Efforts to obtain additional information from author were unsuccessful.
Blinding (performance bias and detection bias) Subcutaneous lignocaine	High risk	No subcutaneous placebo
Blinding (performance bias and detection bias) Intravenous pain regimens	Low risk	Appropriate blinding of participants, clinicians and assessors for intravenous arms (IV placebo, mixed in pharmacy and diluted to same volume)
Incomplete outcome data (attrition bias) All outcomes	Low risk	No missing outcome data
Selective reporting (reporting bias)	Low risk	No evidence of selective outcome reporting for primary outcomes. Data were not reported by treatment group for secondary outcomes. This meant that meta‐analysis was not possible but this is unlikely to change the conclusions of the review.
Other bias	Low risk	Statistical adjustment performed for use of fentanyl as co‐intervention