Tang Yi, Tang Xu, Wei Qinghua, Zhang Hui
Department of Orthopedics, People's Hospital of JianYang, No. 180, Yiyuan Road, Jiancheng zhen, Jianyang, Sichuan Province, China.
J Orthop Surg Res. 2017 Aug 16;12(1):125. doi: 10.1186/s13018-017-0621-0.
This 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).
In 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.
Five 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.
Some 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.
本荟萃分析旨在阐明鞘内注射吗啡（ITM）与股神经阻滞（FNB）在全膝关节置换术（TKA）后控制疼痛方面的疗效和安全性。
2017年4月，在PubMed、EMBASE、科学网、Cochrane系统评价数据库、Cami Info. Inc.、Casalini数据库、EBSCO数据库、Verlag数据库和谷歌数据库中进行了基于计算机的系统检索。收集了在TKA后比较ITM与FNB控制疼痛的研究中准备接受TKA手术患者的数据。主要结局指标为术后6、12、24、48和72小时的视觉模拟评分（VAS）以及12、24和48小时的吗啡总消耗量。次要结局指标为并发症，包括术后恶心呕吐（PONV）和瘙痒。使用Stata 12.0对数据进行汇总。
最终共有5项临床研究、225例患者（ITM组=114例，FNB组=111例）纳入荟萃分析。结果显示，ITM组在术后6、12、24、48和72小时VAS降低，在12、24和48小时吗啡总消耗量减少。两组PONV发生率无显著差异。然而，ITM组TKA后瘙痒发生率增加。
与FNB相比，ITM给药可获得一些即时镇痛效果和节省阿片类药物的作用。ITM组瘙痒并发症多于FNB组。纳入研究的样本量和质量有限。需要进行多中心随机对照试验以确定TKA后实现最大疼痛控制的最佳方法。
