Reference | Intervention | Baseline pain scores | Postintervention pain scores | Statistical difference between intervention and control | Secondary outcomes | Adverse effects |
Vahidi et al 32 | Intravenous lidocaine versus intravenous morphine sulfate | Mean VAS 7.50±1.93 | Intervention: 15 min: 5.75±1.77 30 min: 4.25±1.48 Control: 15 min: 7.00±1.83 30 min: 6.50±1.73 | 15 min: mean difference 1.25 (95% CI 0.095 to 2.405) 30 min: mean difference 2.25 (95% CI 1.218 to 3.282) | None | None |
Morris-Stiff et al 35 | Gabapentin: median dose 1271 mg/24 hours | Median VAS 9 | Day 4: 7 (p=0.001) Day 7: 7 (p=0.0002) Day 14: 6 (p=0.0004) Day 28: 5 (p=0.0003) | No control | Reduction in night pain in 15/16 patients Reduction in opioid requirements in 5/17. No increase in opioid dose required | None |
Aurilio et al 36 | Buprenorphine transdermal patch+epidural ropivacaine+morphine versus placebo patch+epidural ropivacaine+morphine alone | Mean VAS: Intervention 84.9±3.38 Control 84.8±3.41 | At end point: Intervention 10.31±2.13 Control 19.4±1.95 | Intervention versus control (p<0.0001 95% CI −10.4 to −8.3) | Statistical significant improvements in intervention vs control in SF-MPQ total, SF-MPQ PPI, Sleepinterference (All p<0.0001) Lower number of patients requiring rescue morphine No significant differences in the neurobehavioural status of the patients (p<0.165) | No side effects in 18 patients in intervention versus 8 in control More SEs (drowsiness, fatigue, constipation, nausea) in control In the control group, two patients (4.7%) suffered significant nausea causing them to withdraw from trial |
Aurilio et al 28 | Buprenorphine transdermal patch+epidural ropivacaine+morphine versus epidural ropivacaine+morphine alone | Mean VAS: Intervention 85 Control 85 | At 15 days: Intervention 20 Control 38 At 30 days: Intervention 10 Control 20 | No statistical tests performed | Hours of sleep 3.5 to 5 to 8 hours vs 3.5 to 4.5 to 6 hours in control No patients for additional morphine in intervention, 11 in control | No side effects in 12 patients in intervention versus 6 in control More SEs (drowsiness, fatigue, constipation, nausea) in control 1 withdrawal in control due to nausea |
Mitchell and Fallon33 | Intravenous ketamine versus intravenous normal saline | Pain relief score (mean): Intervention 50 Control 58 Mean ‘average pain score’: Intervention 5.9 Control 5.8 | Pain relief score: Intervention (24 hours post): 65 Control (24 hours post): 56 Mean ‘average pain score’: Intervention (24 hours post): 5.1 Control (24 hours post): 6.3 | 17% difference in means of pain relief scores (95% CI 0.2, 33.8) in favour of ketamine versus control. Statistical significance (p<0:05) improvement in the average daily pain scores in the ketamine group | Improvement in effect of pain on general activity (p<0.03) and enjoyment of life (p<0.004) No significant difference in opioid consumption | In ketamine group 33% (n=6) reported feeling more emotional than usual 24 hours after infusion, only 6% (n=1) of placebo group (OR of 7.7, p<0:05) 7 patients withdrew for reasons not related to intervention |
Persson et al 34 | Intravenous ketamine versus intravenous morphine | Baseline pain ratings ranged from 0.3 to 10 | Ketamine 0.30 mg/kg: total pain relief in 7/8 patients Ketamine 0.45 mg/kg: total pain relief in 8/8 patients Pain relief (median value) of approximately 50% at 60 min | At 5 min: 0.45 mg/kg dose statistical significant difference (p=0.010) and 0.30 mg/kg dose (p=0.05) The 0.15 mg/kg dose was not significant (p>0.05) At 10 min: only 0.45 mg/kg significantly different from morphine (0.05 level) At peak effects 0.45 mg/kg ketamine versus 10 mg morphine (5 and 20 min, respectively): not significantly different (p<0.10, Wilcoxon test) | None | Ketamine: all patients had perceptual disturbances and psychotropic effects (dose dependent) At 0.45 mg/kg dose all had ‘unacceptable’ SE Highest dose ketamine: mean BP rise ~10% HR changes within the limits of +10 beats/min for all doses |
PPI, present pain intensity; SF-MPQ, Short-Form McGill Pain Questionnaire; VAS, visual analogue scale.