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Title

Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing major surgery: meta-analysis of randomized trials

Authors
Meylan, N.
Published in British Journal of Anaesthesia. 2009, vol. 102, no. 2, p. 156-167
Abstract Intrathecal morphine without local anaesthetic is often added to a general anaesthetic to prevent pain after major surgery. Quantification of benefit and harm and assessment of dose-response are needed. We performed a meta-analysis of randomized trials testing intrathecal morphine alone (without local anaesthetic) in adults undergoing major surgery under general anaesthesia. Twenty-seven studies (15 cardiac-thoracic, nine abdominal, and three spine surgery) were included; 645 patients received intrathecal morphine (dose-range, 100-4000 microg). Pain intensity at rest was decreased by 2 cm on the 10 cm visual analogue scale up to 4 h after operation and by about 1 cm at 12 and 24 h. Pain intensity on movement was decreased by 2 cm at 12 and 24 h. Opioid requirement was decreased intraoperatively, and up to 48 h after operation. Morphine-sparing at 24 h was significantly greater after abdominal surgery {weighted mean difference, -24.2 mg [95% confidence interval (CI) -29.5 to -19.0]}, compared with cardiac-thoracic surgery [-9.7 mg (95% CI -17.6 to -1.80)]. The incidence of respiratory depression was increased with intrathecal morphine [odds ratio (OR) 7.86 (95% CI 1.54-40.3)], as was the incidence of pruritus [OR 3.85 (95% CI 2.40-6.15)]. There was no evidence of linear dose-responsiveness for any of the beneficial or harmful outcomes. In conclusion, intrathecal morphine decreases pain intensity at rest and on movement up to 24 h after major surgery. Morphine-sparing is more pronounced after abdominal than after cardiac-thoracic surgery. Respiratory depression remains a major safety concern.
Keywords Analgesics, Opioid/*administration & dosage/adverse effectsAnesthesia, GeneralAnesthetics, LocalDose-Response Relationship, DrugDrug Administration ScheduleHumansInjections, SpinalMorphine/*administration & dosage/adverse effectsPain Measurement/methodsPain, Postoperative/*prevention & controlRandomized Controlled Trials as TopicRespiratory Insufficiency/chemically induced
Identifiers
PMID: 19151046
Full text
Article - document accessible for UNIGE members only Limited access to UNIGE
Other version: http://bja.oxfordjournals.org/content/102/2/156.full.pdf
Structures
Research group La Médecine Périopératoire et l'anesthésie (70)
Citation
(ISO format)
MEYLAN, N. et al. Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing major surgery: meta-analysis of randomized trials. In: British Journal of Anaesthesia, 2009, vol. 102, n° 2, p. 156-167. https://archive-ouverte.unige.ch/unige:19967

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Deposited on : 2012-04-23

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