Comparison of intrathecal and local infiltration analgesia by morphine for pain management in total knee and hip arthroplasty: A meta-analysis of randomized controlled trial

Int J Surg. 2017 Apr:40:97-108. doi: 10.1016/j.ijsu.2017.02.060. Epub 2017 Feb 24.

Abstract

Objective: We performed a meta-analysis from randomized controlled trials to evaluate the efficiency and safety between local infiltration analgesia and intrathecal morphine for pain control in total knee and hip arthroplasty.

Methods: We systemically searched electronic databases including Embase (1980-2016.7), Medline (1966-2016.7), PubMed (1966-2016.7), ScienceDirect (1985-2016.7), web of science (1950-2016.7) and Cochrane Library for relevant articles. All calculation was carried out by Stata 11.0.

Results: Four randomized controlled trials (RCTs) involving 242 patients met the inclusion criteria. The meta-analysis showed that there were significant differences in terms of postoperative pain scores at 24 h during rest (P = 0.008) and mobilization (P = 0.049) following total knee and hip arthroplasty. Significant difference was found regarding the incidence of nausea (P = 0.030), vomiting (P = 0.005), and pruritus (P = 0.000) between two groups. There was no significant difference between groups in terms of morphine equivalent consumption at postoperative 24 or 48 h.

Conclusions: Local infiltration analgesia (LIA) provided superior analgesic effects within the first 24 h compared to intrathecal morphine (ITM) following total knee and hip arthroplasty. There were fewer adverse effects in LIA. Doses of morphine consumption were similar in the two groups.

Keywords: Intrathecal morphine; Local infiltration analgesia; Meta-analysis; Total knee and hip arthroplasty.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Aged
  • Analgesia / adverse effects
  • Analgesics, Opioid / administration & dosage*
  • Analgesics, Opioid / adverse effects
  • Anesthetics, Local
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Arthroplasty, Replacement, Knee / adverse effects*
  • Female
  • Humans
  • Injections, Spinal
  • Male
  • Middle Aged
  • Morphine / administration & dosage*
  • Morphine / adverse effects
  • Pain Management / methods*
  • Pain, Postoperative / drug therapy*
  • Pain, Postoperative / etiology

Substances

  • Analgesics, Opioid
  • Anesthetics, Local
  • Morphine