Orthopedic Surgery

Intraosseous Morphine During Total Knee Arthroplasty Reduces Pain, Hospital Stay

Intraosseous (IO) infusion of medication during surgery has been shown to be a new and effective way to manage pain in patients undergoing total knee arthroplasty (TKA), according to a recent study.

To determine the safety and efficacy of injecting pain medication directly into the tibia during surgery and the impact that this method may have on pain levels and time spent in the hospital, the researchers performed a double-blind, randomized controlled study examining patients undergoing TKA (n = 48). The patients were divided into 2 groups: the experimental group (n = 24) who received both an IO antibiotic injection and 10 mg of morphine, and the control group (n = 24) who received only a standard IO injection of antibiotics.

The researchers assessed pain, nausea, and opioid use up to 14 days post-surgery for all patients. Additionally, the researchers examined morphine and interleukin-6 serum levels in a subgroup of 20 patients 10 hours post-surgery.

The researchers used the Visual Analog Scale to determine the level of pain each patient had postoperatively. Patients in the experimental group had a lower pain score at 1-, 2-, 3-, and 5-hours post-surgery (P = .0032, P = .005, P = .020, P = .10) when compared with the control group. The decrease in pain continued for postoperative day 1 (40% reduction, P = .01), day 2 (49% reduction, P = .036), day 8 (38% reduction, P = .025), and day 9 (33% reduction, P = .041).

Furthermore, the researchers saw a lower opioid consumption within the first 48 hours and the 2nd-week post-surgery among the experimental group when compared with the control group (P < .05). Serum morphine levels in were significantly less in the experimental group than in the control group 10 hours after IO injection (P = .049). The experimental group also has significant improvement (P < .05) in the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores at 2- and 8-weeks post-surgery.

Overall, the experimental group showed significant improvement and outcome post-surgery.

“IO morphine combined with a standard antibiotic solution demonstrates superior postoperative pain relief immediately and up to 2 weeks,” the researchers concluded. “IO morphine is a safe and effective method to lessen postoperative pain in TKA patients.”


—Jessica Ganga


Brozovich AA, Incavo SJ, Lambert BS, et al. Intraosseous morphine decreases postoperative pain and pain medication use in total knee arthroplasty: a double-blind, randomized controlled trial. J Arthroplasty. 2022;37(6):139-146. doi:10.1016/j.arth.2021.10.009.