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

• Published in: International journal of surgery (London, England) Vol. 40; pp. 97 - 108
• Main Authors: Jia, Xu-feng, M.D, Ji, Yong, M.D, Huang, Guang-ping, M.D, Zhou, Yu, M.D, Long, Miao, M.D
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.04.2017
• Subjects: 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; Intrathecal morphine; Local infiltration analgesia; Male; Meta-analysis; Middle Aged; Morphine - administration & dosage; Morphine - adverse effects; Pain Management - methods; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Surgery; Total knee and hip arthroplasty; Local infiltration analgesia; Total knee and hip arthroplasty; Intrathecal morphine; Meta-analysis
• ISSN: 1743-9191; 1743-9159
• DOI: 10.1016/j.ijsu.2017.02.060

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.