Single-dose intra-articular bupivacaine plus morphine versus bupivacaine alone after arthroscopic knee surgery: a meta-analysis of randomized controlled trials.
OBJECTIVE
The purpose of this meta-analysis was to compare the efficacy and safety of single-dose intra-articular bupivacaine plus morphine versus bupivacaine alone for pain management following arthroscopic knee surgery.


METHODS
A comprehensive literature search was conducted to identify randomized controlled trials that used single-dose intra-articular bupivacaine plus morphine and bupivacaine alone for post-operative pain, using MEDLINE (1966-2014), 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
A total of twenty-nine trials (n = 1167) were included. The post-operative visual analog scale (VAS) pain score of the bupivacaine plus morphine group compared with the bupivacaine alone group was significantly lower (WMD -1.15, 95 % CI -1.67 to -0.63, p < 0.0001). As far as safety, there was no significant difference in side effects between the two groups (RR 1.10, 95 % CI 0.59-2.04, n.s.). Sensitivity analyses suggested that the results of these two primary outcomes were stable and reliable. However, the current evidence did not suggest a superior effect with respect to the time to first analgesic request (WMD 51.33, 95 % CI -110.99 to 213.65, n.s.) and the number of patients requiring supplementary analgesia (RR 1.13, 95 % CI 0.92-1.39, n.s.).


CONCLUSIONS
On the basis of the currently available literature, this study is the first to suggest that single-dose intra-articular bupivacaine plus morphine was shown to be significantly better than bupivacaine alone at relieving post-operative pain after arthroscopic knee surgery without increasing the short-term side effects. Routine use of single-dose intra-articular bupivacaine plus morphine is an effective way for pain management after arthroscopic knee surgery.


METHODS
II.
Department of Orthopaedics, Xiangya Hospital, Central South University, #87 Xiangya Road, Changsha, 410008, Hunan Province, China.
Ye
Y
Yang
Department of Orthopaedics, Xiangya Hospital, Central South University, #87 Xiangya Road, Changsha, 410008, Hunan Province, China.
Chao
C
Zeng
Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, 410008, Hunan Province, China.
Jie
J
Wei
Department of Orthopaedics, Xiangya Hospital, Central South University, #87 Xiangya Road, Changsha, 410008, Hunan Province, China.
Hui
H
Li
Department of Orthopaedics, Xiangya Hospital, Central South University, #87 Xiangya Road, Changsha, 410008, Hunan Province, China.
Tuo
T
Yang
Department of Orthopaedics, Xiangya Hospital, Central South University, #87 Xiangya Road, Changsha, 410008, Hunan Province, China.
Zhen-Han
ZH
Deng
Department of Orthopaedics, Xiangya Hospital, Central South University, #87 Xiangya Road, Changsha, 410008, Hunan Province, China.
Yu-Sheng
YS
Li
Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, 410008, Hunan Province, China.
Tu-Bao
TB
Yang
Department of Orthopaedics, Xiangya Hospital, Central South University, #87 Xiangya Road, Changsha, 410008, Hunan Province, China. lgh9640@sina.cn.
Guang-Hua
GH
Lei
D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D001182:Arthroscopy / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007717:Knee / Q000601:surgery*; D008297:Male; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine
Analgesics; Arthroscopy; Bupivacaine; Morphine