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

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
PMID: 19151046
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Other version: http://bja.oxfordjournals.org/content/102/2/156.full.pdf
Research group La Médecine Périopératoire et l'anesthésie (70)
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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. doi: 10.1093/bja/aen368 https://archive-ouverte.unige.ch/unige:19967

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Deposited on : 2012-04-23

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