Medical Student, Faculty of Medicine, Alexandria University, Alexandria, Egypt; International Medical Students' Research Association (IMedRA), Cairo, Egypt. ORCID: https://orcid.org/0000-0002-9078-5774.
Al Andalus University, Tartus, Syria; International Medical Students' Research Association (IMedRA), Cairo, Egypt.
J Opioid Manag. 2021 Sep-Oct;17(5):405-416. doi: 10.5055/jom.2021.0674.
Morphine is a potent analgesic used to manage the pain following total knee arthroplasty (TKA). We aim to assess the safety and efficacy of intrathecal morphine (ITM) compared with placebo following TKA.
We systematically searched four databases for trials that study the safety and efficacy of ITM in TKA. From relevant studies, data were extracted and pooled as mean difference (MD) or standardized mean difference (SMD) with 95 percent confidence interval (CI) using Review Manager software (Version 5.3).
We included six randomized controlled trials in our study. ITM significantly reduced pain scores at 4 hours (SMD = -0.82, 95 percent CI [-1.52, -0.12], p = 0.02) and 24 hours (MD = -2.01, 95 percent CI [-2.93, -1.09], p = 0.0001) after surgery compared to placebo. No statistically significant difference in cumulative morphine use or nausea episodes was observed after 24 hours. ITM in-creased the risk of pruritus more than placebo (relative risk [RR] = 4.82, 95 percent CI [2.34, 9.93], p < 0.0001).
ITM reduces pain at 4 and 24 hours post-operatively with no effect on cumulative morphine consumption. The only feared side effect is pruritus.
吗啡是一种强效镇痛药，用于治疗全膝关节置换术（TKA）后的疼痛。我们旨在评估鞘内注射吗啡（ITM）与 TKA 后安慰剂相比的安全性和疗效。
我们系统地在四个数据库中搜索了研究 ITM 在 TKA 中安全性和疗效的试验。从相关研究中提取数据，并使用 Review Manager 软件（版本 5.3）以均数差（MD）或标准化均数差（SMD）和 95%置信区间（CI）进行汇总。
我们的研究纳入了六项随机对照试验。与安慰剂相比，ITM 显著降低了术后 4 小时（SMD=-0.82，95%CI[-1.52，-0.12]，p=0.02）和 24 小时（MD=-2.01，95%CI[-2.93，-1.09]，p=0.0001）的疼痛评分。术后 24 小时，累积吗啡使用量或恶心发作无统计学差异。与安慰剂相比，ITM 增加了瘙痒的风险（相对风险[RR]=4.82，95%CI[2.34，9.93]，p<0.0001）。
ITM 可降低术后 4 小时和 24 小时的疼痛，对累积吗啡使用量无影响。唯一令人担忧的副作用是瘙痒。
