Comparison between subarachnoid morphine and femoral nerve block for analgesia after knee ligament reconstruction: a randomized clinical trial

Fiorentin, Joana Zulian; Martins, Alexandre Vieira; Cañola, Juan Manuel Vélez; Gutierrez, Linda Cecilia; Perches, Fábio; Sakae, Thiago Mamôru; Tenório, Sérgio Bernardo

doi:10.1016/j.bjane.2019.10.007

Cited by 2 publications

(15 citation statements)

References 22 publications

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“…This allows morphine to come into contact with emetogenic centers located in the area postrema. 24 This upward movement has been confirmed, among other ways, by demonstrating that the onset of nausea and vomiting coincides with the onset of analgesia at the trigeminal level. 25 Although a proportion of fentanyl is absorbed systemically and by this route can also reach the trigeminal center, perhaps the concentrations do not reach such triggering levels of nausea and vomiting, as occurs with morphine.…”

Section: Discussionmentioning

confidence: 74%

Morphine - bupivacaine and bupivacaine in gynecological surgeries

Perón¹,

Rodríguez²

2022

MOJS

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Objective: Evaluate the intrathecal use of morphine-bupivacaine and bupivacaine in gynecological surgeries. Material and methods: An analytic longitudinal prospective study was perfomed at the Manuel Piti Fajardo Hospital in Florida, from February 2019 to March 2020. The universe was compound by 180 patients. Sample was select about 60 patients by probabilistic simple randon sampling distributed in two groups: A (Morphine -Bupivacaine) and B (Bupivacaine) according to inclusion criteria. The data were collected in questionnaire properly to investigation with baseline data in Statistical Package for Social Sciences. A univariate and multivariate analysis were conducted. Results: Complications and adverse reactions and their probability of presentation in the morphine=bupivacaine group was greater, pruritus (3.5 times), nausea and vomiting (2.8 times), hypotension (2.1 times) and urinary retention (2.1 times) corroborated by confidence intervals.This group had ten times more probability to have tolerable trouble or no pain (QR=10,2) that bupivacaine group, all of which showed moderate to several pain;10 times more probability of analgesia greater to 24 hours (QR=10,7) compared to bupivacaine and 8 times more likely to perceive good satisfaction. Conclusions: Evaluation of pain postoperative and analgesic time were better in patients managed with morphine =bupivacaine that resulted in analgesic of the greatest quality although prevailed pruritus, nausea and vomiting, hypotension and urinary retention like adverse reactions.

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Section: Discussionmentioning

confidence: 74%

Morphine - bupivacaine and bupivacaine in gynecological surgeries

Perón¹,

Rodríguez²

2022

MOJS

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“…The full details of the regional anaesthetic techniques are shown in online Supporting Information (Appendix S3). Briefly, ultrasound guidance alone was used by 14 studies [69, 70, 75, 83, 84, 89, 92, 95, 101, 102, 108, 110, 112, 116], nerve stimulation alone in 18 studies [81, 85, 87, 90, 93, 96, 97, 103, 105, 106, 111, 114, 115, 120, 121, 123, 124, 129] or either ultrasound and/or nerve stimulation guidance in eight studies [71, 72, 77, 78, 82, 91, 109, 113]. One study [104] did not specify nerve localisation technique.…”

Section: Resultsmentioning

confidence: 99%

“…Of these, 34 were excluded due to their lack of randomised nature or being a crossover design (n = 2) [35, 36]; having an ineligible surgery or not having data for the ACL subgroup (n = 5) [37–41]; not having an active comparator group (n = 2) [42, 43]; or being the only study identified evaluating the specific comparison (n = 25) [44–68]. Subsequently, a total of 61 [69–129] full text randomised trials were considered for inclusion; however, after additional review, four [125–128] were excluded due to evaluating a technique that was not attached to any of the other nodes in the network. Thus, a total of 57 [69–124, 129] full‐text randomised trials were included in the systematic review and network meta‐analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Subsequently, a total of 61 [69–129] full text randomised trials were considered for inclusion; however, after additional review, four [125–128] were excluded due to evaluating a technique that was not attached to any of the other nodes in the network. Thus, a total of 57 [69–124, 129] full‐text randomised trials were included in the systematic review and network meta‐analysis. The flow diagram for study inclusion is depicted in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Across the 57 included trials [69–124, 129], there were a total of 4069 patients who were allocated randomly to receive one of 10 interventions: single‐injection FNB; single‐injection ACB; single‐injection LIA; single‐injection FNB combined with single‐injection SNB; single‐injection FNB combined with single‐injection graft‐donor site infiltration; single‐injection FNB combined with single‐injection LIA; continuous FNB; continuous FNB combined with single‐injection LIA; graft‐donor site infiltration; and systemic analgesia alone (control). Overall, a total of 12 unique direct comparisons were assessed, which are shown Table 1.…”

Section: Resultsmentioning

confidence: 99%

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Network meta‐analysis of the analgesic effectiveness of regional anaesthesia techniques for anterior cruciate ligament reconstruction

et al. 2022

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Summary Anterior cruciate ligament reconstruction can cause moderate to severe acute postoperative pain. Despite advances in our understanding of knee innervation, consensus regarding the most effective regional anaesthesia techniques for this surgical population is lacking. This network meta‐analysis compared effectiveness of regional anaesthesia techniques used to provide analgesia for anterior cruciate ligament reconstruction. Randomised trials examining regional anaesthesia techniques for analgesia following anterior cruciate ligament reconstruction were sought. The primary outcome was opioid consumption during the first 24 h postoperatively. Secondary outcomes were: rest pain at 0, 6, 12 and 24 h; area under the curve of pain over 24 h; and opioid‐related adverse effects and functional recovery. Network meta‐analysis was conducted using a frequentist approach. A total of 57 trials (4069 patients) investigating femoral nerve block, sciatic nerve block, adductor canal block, local anaesthetic infiltration, graft‐donor site infiltration and systemic analgesia alone (control) were included. For opioid consumption, all regional anaesthesia techniques were superior to systemic analgesia alone, but differences between regional techniques were not significant. Single‐injection femoral nerve block combined with sciatic nerve block had the highest p value probability for reducing postoperative opioid consumption and area under the curve for pain severity over 24 h (78% and 90%, respectively). Continuous femoral nerve block had the highest probability (87%) of reducing opioid‐related adverse effects, while local infiltration analgesia had the highest probability (88%) of optimising functional recovery. In contrast, systemic analgesia, local infiltration analgesia and adductor canal block were each poor performers across all analgesic outcomes. Regional anaesthesia techniques that target both the femoral and sciatic nerve distributions, namely a combination of single‐injection nerve blocks, provide the most consistent analgesic benefits for anterior cruciate ligament reconstruction compared with all other techniques but will most likely impair postoperative function. Importantly, adductor canal block, local infiltration analgesia and systemic analgesia alone each perform poorly for acute pain management following anterior cruciate ligament reconstruction.

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Comparison between subarachnoid morphine and femoral nerve block for analgesia after knee ligament reconstruction: a randomized clinical trial

Cited by 2 publications

References 22 publications

Morphine - bupivacaine and bupivacaine in gynecological surgeries

Morphine - bupivacaine and bupivacaine in gynecological surgeries

Network meta‐analysis of the analgesic effectiveness of regional anaesthesia techniques for anterior cruciate ligament reconstruction

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