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...
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MDPI AG
2025-03-01
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| author | Arron W. Gibson Niamh E. Cooper Eric Albrecht Patrice Forget |
| author_facet | Arron W. Gibson Niamh E. Cooper Eric Albrecht Patrice Forget |
| author_sort | Arron W. Gibson |
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| description | <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. |
| format | Article |
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| institution | OA Journals |
| issn | 1424-8247 |
| language | English |
| publishDate | 2025-03-01 |
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| spelling | doaj-art-96e1bace6767469f835dfe4869f1a35e2025-08-20T02:28:15ZengMDPI AGPharmaceuticals1424-82472025-03-0118451210.3390/ph18040512Intrathecal Morphine Versus Other Techniques for Postoperative Pain Management in the Context of Multimodal Analgesia: A Meta-AnalysisArron W. Gibson0Niamh E. Cooper1Eric Albrecht2Patrice Forget3School of Medicine and Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UKSchool of Medicine and Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UKDepartment of Anesthesia, University Hospital of Lausanne, 1011 Lausanne, SwitzerlandPain and Opioids After Surgery (PANDOS) European Society of Anaesthesiology and Intensive Care (ESAIC) Research Group, 1000 Brussels, Belgium<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.https://www.mdpi.com/1424-8247/18/4/512intrathecal morphinemultimodal analgesiapostoperative pain |
| spellingShingle | Arron W. Gibson Niamh E. Cooper Eric Albrecht Patrice Forget Intrathecal Morphine Versus Other Techniques for Postoperative Pain Management in the Context of Multimodal Analgesia: A Meta-Analysis Pharmaceuticals intrathecal morphine multimodal analgesia postoperative pain |
| title | Intrathecal Morphine Versus Other Techniques for Postoperative Pain Management in the Context of Multimodal Analgesia: A Meta-Analysis |
| title_full | Intrathecal Morphine Versus Other Techniques for Postoperative Pain Management in the Context of Multimodal Analgesia: A Meta-Analysis |
| title_fullStr | Intrathecal Morphine Versus Other Techniques for Postoperative Pain Management in the Context of Multimodal Analgesia: A Meta-Analysis |
| title_full_unstemmed | Intrathecal Morphine Versus Other Techniques for Postoperative Pain Management in the Context of Multimodal Analgesia: A Meta-Analysis |
| title_short | Intrathecal Morphine Versus Other Techniques for Postoperative Pain Management in the Context of Multimodal Analgesia: A Meta-Analysis |
| title_sort | intrathecal morphine versus other techniques for postoperative pain management in the context of multimodal analgesia a meta analysis |
| topic | intrathecal morphine multimodal analgesia postoperative pain |
| url | https://www.mdpi.com/1424-8247/18/4/512 |
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