Teunissen Aart Jan W, van Gastel Lieke, Stolker Robert J, Koopman Seppe A
Maasstad Hospital, Anaesthesiology, Rotterdam, the Netherlands.
Erasmus Medical Centre, University Medical Centre Rotterdam, the Netherlands.
BJA Open. 2025 Mar 20;14:100387. doi: 10.1016/j.bjao.2025.100387. eCollection 2025 Jun.
Intrathecal morphine can reduce pain and opioid requirements needed for postoperative pain relief. It can potentially aid in the effectiveness of enhanced recovery protocols in non-abdominal surgery. However, concerns about side-effects may have hindered its use. This scoping review evaluates the effectiveness, appropriate dosage, and adverse effects of intrathecal morphine in non-abdominal surgery.
We systematically searched for randomised controlled trials examining the use of intrathecal morphine in non-abdominal surgery.
The search identified 75 trials involving 4685 patients. We undertook a scoping review of these randomised controlled trials, including bias assessments, to comprehensively analyse the effectiveness and side-effects of intrathecal morphine. The findings indicate that intrathecal morphine reduced postoperative pain and opioid consumption after spinal surgery, thoracic surgery, and orthopaedic lower extremity surgery. However, it was associated with an increased incidence of itching, postoperative nausea and vomiting, and urinary retention, particularly in orthopaedic procedures. Delayed respiratory depression was absent with low to moderate doses (<500 μg) in the reviewed studies.
This review supports the effectiveness of intrathecal morphine in non-abdominal surgery. However, the benefits must be carefully weighed against potential side-effects that could lead to prolonged hospital stays.
PROSPERO-registry CRD42021233936.
鞘内注射吗啡可减轻疼痛并减少术后疼痛缓解所需的阿片类药物用量。它可能有助于提高非腹部手术强化康复方案的有效性。然而，对副作用的担忧可能阻碍了其使用。本综述评估鞘内注射吗啡在非腹部手术中的有效性、合适剂量和不良反应。
我们系统检索了关于鞘内注射吗啡在非腹部手术中应用的随机对照试验。
检索到75项试验，涉及4685例患者。我们对这些随机对照试验进行了综述，包括偏倚评估，以全面分析鞘内注射吗啡的有效性和副作用。结果表明，鞘内注射吗啡可减轻脊柱手术、胸科手术和骨科下肢手术后的疼痛并减少阿片类药物的使用量。然而，它与瘙痒、术后恶心和呕吐以及尿潴留的发生率增加有关，尤其是在骨科手术中。在所审查的研究中，低至中等剂量（<500μg）未出现延迟性呼吸抑制。
本综述支持鞘内注射吗啡在非腹部手术中的有效性。然而，必须仔细权衡其益处与可能导致住院时间延长的潜在副作用。
PROSPERO注册库CRD42021233936。
