Intrathecal morphine versus femoral nerve block for pain control after total knee arthroplasty: a meta-analysis

Abstract

BackgroundThis meta-analysis aims to illustrate the efficacy and safety of intrathecal morphine (ITM) versus femoral nerve block (FNB) for pain control after total knee arthroplasty (TKA).MethodsIn April 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, Cami Info. Inc., Casalini databases, EBSCO databases, Verlag database and Google database. Data on patients prepared for TKA surgery in studies that compared ITM versus FNB for pain control after TKA were collected. The main outcomes were the visual analogue scale (VAS) at 6, 12, 24, 48 and 72 and total morphine consumption at 12, 24 and 48 h. The secondary outcomes were complications that included postoperative nausea and vomiting (PONV) and itching. Stata 12.0 was used for pooling the data.ResultsFive clinical studies with a total of 225 patients (ITM group = 114, FNB group = 111) were ultimately included in the meta-analysis. The results revealed that the ITM group was associated with a reduction of VAS at 6, 12, 24, 48 and 72 h and total morphine consumption at 12, 24 and 48 h. There was no significant difference between the occurrences of PONV. However, the ITM group was associated with an increased occurrence of itching after TKA.ConclusionsSome immediate analgesic efficacy and opioid-sparing effects were obtained with the administration of ITM when compared with FNB. The complications of itching in the ITM group were greater than in the FNB group. The sample size and the quality of the included studies were limited. A multi-centre RCT is needed to identify the optimal method for reaching maximum pain control after TKA.Electronic supplementary materialThe online version of this article (doi:10.1186/s13018-017-0621-0) contains supplementary material, which is available to authorized users.

Comparison of analgesic efficacy between rectus sheath blockade, intrathecal morphine with bupivacaine, and intravenous patient-controlled analgesia in patients undergoing robot-assisted laparoscopic prostatectomy: a prospective, observational clinical study

“…Our ITMB data are similar to those of previous laparoscopic and open surgery reports [5,[22][23][24]; thus, ITMB is a feasible and practicable form of pain relief (yielding a lower pain score and lower opioid requirement). Moreover, it was not associated with serious complications (such as nerve injury) during or after surgery, and was better than RSB or IV-PCA alone.…”

Analgesic Efficacy of Rectus Sheath Bupivacaine and Intrathecal Morphine With Bupivacaine Compared to Intravenous Patient-controlled Analgesia in Males Undergoing Robot-Assisted Laparoscopic Prostatectomy: A Prospective, Observational Parallel-Cohort Study

“…A urological study suggested that multimodal pain control via intrathecal bupivacaine/morphine may optimally improve the quality of early recovery and reduce postoperative pain, being associated with less pain during exertion and fewer bladder spasms (compared to a control group) [5]. Our ITMB block data are similar to those of previous laparoscopic or open surgery reports [5,[14][15][16]; the ITMB block was a feasible and practicable form of pain relief, not associated with serious complications (such as nerve injury) during or after surgery, and was better than the RSB or IV-PCA alone.…”

“…One retrospective study comparing intrathecal and peripheral postoperative blocks for patients, including those undergoing robotic pancreatoduodenectomy, suggested that intrathecal morphine administration was signi cantly associated with a lower pain score and a lower opioid requirement soon after surgery than were a tap block and a quadratus lumborum nerve block [14]. In an orthopedic study, intrathecal morphine seemed to be more reliable in terms of analgesic e cacy and opioid-sparing than a femoral nerve block [15]. In a gynecological study, the addition of intrathecal bupivacaine to intrathecal morphine signi cantly improved postoperative pain relief, but the addition of rectus sheath bupivacaine to intrathecal morphine did not afford additional analgesia [16].…”

The effect of musical interventions in improving short-term pain outcomes following total knee replacement: a meta-analysis and systematic review

“…Total knee replacement has achieved good therapeutic effects in easing pain and improving functional outcomes for patients with rheumatoid arthritis or knee osteoarthritis [1,2]. Approximately 100, 000 TKR operations are performed each year in the UK [3].…”