Intrathecal Morphine Versus Other Techniques for Postoperative Pain Management in the Context of Multimodal Analgesia: A Meta-Analysis
<b>Objective</b>: 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 explori...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-03-01
|
| Series: | Pharmaceuticals |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1424-8247/18/4/512 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | <b>Objective</b>: 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. <b>Methods</b>: 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. <b>Results</b>: 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], <i>p</i> < 0.001, I<sup>2</sup> = 0%) and on movement (MD = 1.27 [0.44, 2.10], <i>p</i> = 0.003, I<sup>2</sup> = 0%). Cumulative opioid consumption was reduced in ITM groups (MD = −11.61 [−18.73, −4.50], <i>p</i> = 0.001, I<sup>2</sup> = 95%), with significantly increased risk of pruritus (<i>p</i> < 0.001) but not nausea and vomiting (<i>p</i> = 0.93). There was no evidence of respiratory depression. <b>Conclusions</b>: 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. |
|---|---|
| ISSN: | 1424-8247 |