Efficacy and safety of intrathecal morphine in total knee arthroplasty: A systematic review and meta-analysis

Yossef Hassan AbdelQadir; Ayman Essa Nabhan; Eman Abdelbaset Abdelghany; Alshaimaa Galal Mohamed; Abdelrahman Shawky El Tokhey; Aya Abd Elmegeed; Anas Zakarya Nourelden; Khaled Mohamed Ragab

doi:10.5055/jom.2021.0674

Authors

Yossef Hassan AbdelQadir https://orcid.org/0000-0002-9078-5774
Ayman Essa Nabhan
Eman Abdelbaset Abdelghany
Alshaimaa Galal Mohamed
Abdelrahman Shawky El Tokhey
Aya Abd Elmegeed
Anas Zakarya Nourelden
Khaled Mohamed Ragab

DOI:

https://doi.org/10.5055/jom.2021.0674

Keywords:

total knee arthroplasty, knee surgery, intrathecal morphine, meta-analysis

Abstract

Objective: Morphine is a potent analgesic used to manage the pain following total knee arthroplasty (TKA). We aim to assess the safety and efficacy of intrathecal morphine (ITM) compared with placebo following TKA.

Methods: We systematically searched four databases for trials that study the safety and efficacy of ITM in TKA. From relevant studies, data were extracted and pooled as mean difference (MD) or standardized mean difference (SMD) with 95 percent confidence interval (CI) using Review Manager software (Version 5.3).

Results: We included six randomized controlled trials in our study. ITM significantly reduced pain scores at 4 hours (SMD = –0.82, 95 percent CI [–1.52, –0.12], p = 0.02) and 24 hours (MD = –2.01, 95 percent CI [–2.93, –1.09], p = 0.0001) after surgery compared to placebo. No statistically significant difference in cumulative morphine use or nausea episodes was observed after 24 hours. ITM increased the risk of pruritus more than placebo (relative risk [RR] = 4.82, 95 percent CI [2.34, 9.93], p < 0.0001).

Conclusion: ITM reduces pain at 4 and 24 hours post-operatively with no effect on cumulative morphine consumption. The only feared side effect is pruritus.

Author Biographies

Yossef Hassan AbdelQadir

Medical Student, Faculty of Medicine, Alexandria University, Alexandria, Egypt; International Medical Students’ Research Association (IMedRA), Cairo, Egypt

Ayman Essa Nabhan

Student, Faculty of Medicine, Al Andalus University, Tartus, Syria; International Medical Students’ Research Association (IMedRA), Cairo, Egypt

Eman Abdelbaset Abdelghany

Student, Faculty of Medicine, Alexandria University, Alexandria, Egypt; International Medical Students’ Research Association (IMedRA), Cairo, Egypt

Alshaimaa Galal Mohamed

Student, Faculty of Medicine, Fayoum University, Fayoum, Egypt; International Medical Students’ Research Association (IMedRA), Cairo, Egypt

Abdelrahman Shawky El Tokhey

Student, Faculty of Medicine, Assuit University, Assuit, Egypt; International Medical Students’ Research Association (IMedRA), Cairo, Egypt

Aya Abd Elmegeed

Student, Faculty of Science, Menoufia University, Menoufia, Egypt; International Medical Students’ Research Association (IMedRA), Cairo, Egypt

Anas Zakarya Nourelden

Student, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; International Medical Students’ Research Association (IMedRA), Cairo, Egypt

Khaled Mohamed Ragab

Student, Faculty of Medicine, Minia University, Minia, Egypt; International Medical Students’ Research Association (IMedRA), Cairo, Egypt

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