Gibson Arron W, Cooper Niamh E, Albrecht Eric, Forget Patrice
School of Medicine and Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK.
Department of Anesthesia, University Hospital of Lausanne, 1011 Lausanne, Switzerland.
Pharmaceuticals (Basel). 2025 Mar 31;18(4):512. doi: 10.3390/ph18040512.
: Intrathecal morphine (ITM) has been administered in recent years to provide postoperative pain control in non-obstetric surgery; however, current research has limited consideration of the recommendations for regular, basic analgesia from clinical guidelines when exploring its efficacy. This systematic review and meta-analysis aimed to compare ITM against alternative methods of analgesia in the presence of multimodal analgesia, for reducing pain scores within the first 24 h postoperatively. Secondary outcomes included postoperative opioid consumption, incidence of opioid-related effects, and time to mobilisation. : Database searches and screening identified 11 trials for inclusion in this review. Pain scores were compared by meta-analysis at 6, 12, and 24 h postoperatively at rest and on movement, with sub-analysis of systemic versus regional techniques. : The data found no significant difference between ITM and active comparators for reducing pain scores at rest or on movement at any of the time intervals explored. Sub-analysis demonstrated that regional techniques may provide superior analgesia at 24 h at rest (MD = -1.19; 95% CI [-1.73, -0.66], < 0.001, I = 0%) and on movement (MD = 1.27 [0.44, 2.10], = 0.003, I = 0%). Cumulative opioid consumption was reduced in ITM groups (MD = -11.61 [-18.73, -4.50], = 0.001, I = 95%), with significantly increased risk of pruritus ( < 0.001) but not nausea and vomiting ( = 0.93). There was no evidence of respiratory depression. : This meta-analysis was unable to demonstrate any significant benefit to postoperative pain relief with the use of ITM but may suggest that it is as a viable option compared to other active modalities. However, this meta-analysis was limited by a low quantity and quality of data from which to draw conclusions and demonstrated high statistical fragility. We believe this highlights a significant gap in the current literature on ITM.
近年来，鞘内注射吗啡（ITM）已被用于非产科手术的术后疼痛控制；然而，目前的研究在探讨其疗效时，对临床指南中常规基本镇痛建议的考虑有限。本系统评价和荟萃分析旨在比较在多模式镇痛的情况下，ITM与其他镇痛方法在术后24小时内降低疼痛评分的效果。次要结局包括术后阿片类药物消耗量、阿片类药物相关效应的发生率以及活动时间。通过数据库检索和筛选，确定了11项试验纳入本评价。通过荟萃分析比较术后6、12和24小时静息和活动时的疼痛评分，并对全身与区域技术进行亚组分析。数据发现在任何所探讨的时间间隔内，ITM与活性对照在静息或活动时降低疼痛评分方面均无显著差异。亚组分析表明，区域技术在术后24小时静息时（MD = -1.19；95% CI [-1.73, -0.66]，P < 0.001，I² = 0%）和活动时（MD = 1.27 [0.44, 2.10]，P = 0.003，I² = 0%）可能提供更好的镇痛效果。ITM组的累积阿片类药物消耗量减少（MD = -11.61 [-18.73, -4.50]，P = 0.001，I² = 95%），瘙痒风险显著增加（P < 0.001），但恶心和呕吐风险无显著增加（P = 0.93）。没有呼吸抑制的证据。本荟萃分析未能证明使用ITM对术后疼痛缓解有任何显著益处，但可能表明与其他活性方式相比，它是一个可行的选择。然而，本荟萃分析受到数据量少和质量低的限制，难以得出结论，且显示出较高的统计脆弱性。我们认为这凸显了当前关于ITM的文献中的一个重大空白。
