Single-dose intra-articular bupivacaine plus morphine versus bupivacaine alone after arthroscopic knee surgery: a meta-analysis of randomized controlled trials

  • Ye Yang
  • Chao Zeng
  • Jie Wei
  • Hui li
  • Tuo Yang
  • Zhen-han Deng
  • Yu-sheng Li
  • Tu-bao Yang
  • Guang-hua Lei



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.


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.


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.).


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.

Level of evidence



Analgesics Bupivacaine Morphine Arthroscopy 



This work was supported by Hunan Provincial Innovation Foundation For Postgraduate (CX2014A005), the Fundamental Research Funds for the Central Universities of Central South University, the National Natural Science Foundation of China (Nos. 81201420, 81272034 and 81472130), the Provincial Science Foundation of Hunan (No. 14JJ3032), the Scientific Research Project of the Development and Reform Commission of Hunan Province ([2013]1199), the Scientific Research Project of Science and Technology Office of Hunan Province (2013SK2018) and the Doctoral Scientific Fund Project of the Ministry of Education of China (20120162110036).

Contribution of authors

All authors made substantial contributions to all three sections: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of the data, (2) the drafting of the article or revising it critically for important intellectual content and (3) final approval of the version submitted.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  • Ye Yang
    • 1
  • Chao Zeng
    • 1
  • Jie Wei
    • 2
  • Hui li
    • 1
  • Tuo Yang
    • 1
  • Zhen-han Deng
    • 1
  • Yu-sheng Li
    • 1
  • Tu-bao Yang
    • 2
  • Guang-hua Lei
    • 1
  1. 1.Department of Orthopaedics, Xiangya HospitalCentral South UniversityChangshaChina
  2. 2.Department of Epidemiology and Health Statistics, School of Public HealthCentral South UniversityChangshaChina

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