Intrathecal morphine versus femoral nerve block for pain control after total knee arthroplasty: a meta-analysis

Yi Tang,Hui Zhang,Xu Tang,Qinghua Wei

doi:10.1186/s13018-017-0621-0

Abstract

BackgroundThis meta-analysis aims to illustrate the efficacy and safety of intrathecal morphine (ITM) versus femoral nerve block (FNB) for pain control after total knee arthroplasty (TKA).MethodsIn April 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, Cami Info. Inc., Casalini databases, EBSCO databases, Verlag database and Google database. Data on patients prepared for TKA surgery in studies that compared ITM versus FNB for pain control after TKA were collected. The main outcomes were the visual analogue scale (VAS) at 6, 12, 24, 48 and 72 and total morphine consumption at 12, 24 and 48 h. The secondary outcomes were complications that included postoperative nausea and vomiting (PONV) and itching. Stata 12.0 was used for pooling the data.ResultsFive clinical studies with a total of 225 patients (ITM group = 114, FNB group = 111) were ultimately included in the meta-analysis. The results revealed that the ITM group was associated with a reduction of VAS at 6, 12, 24, 48 and 72 h and total morphine consumption at 12, 24 and 48 h. There was no significant difference between the occurrences of PONV. However, the ITM group was associated with an increased occurrence of itching after TKA.ConclusionsSome immediate analgesic efficacy and opioid-sparing effects were obtained with the administration of ITM when compared with FNB. The complications of itching in the ITM group were greater than in the FNB group. The sample size and the quality of the included studies were limited. A multi-centre RCT is needed to identify the optimal method for reaching maximum pain control after TKA.

Highlights

This meta-analysis aims to illustrate the efficacy and safety of intrathecal morphine (ITM) versus femoral nerve block (FNB) for pain control after total knee arthroplasty (TKA)
The meta-analysis results indicated that ITM can decrease visual analogue scale (VAS) scores at 12 h (WMD = −9.90, 95% Confidence interval (CI) −15.05, −4.74, P = 0.000, Fig. 4) when compared with the FNB group
The results of the meta-analysis indicated that ITM can decrease VAS scores at 24 h (WMD = −10.27, 95% CI −12.16, −8.39, P = 0.001, Fig. 4) when compared with the FNB group

Summary

Introduction

This meta-analysis aims to illustrate the efficacy and safety of intrathecal morphine (ITM) versus femoral nerve block (FNB) for pain control after total knee arthroplasty (TKA). Total knee arthroplasty (TKA) leads to considerable postoperative pain [1, 2]. Ineffective pain control after TKA can cause many side effects [3]. A multimodal technique, a new concept, is accepted by most surgeons. Multimodal analgesia includes regional techniques, systemic opioids and preoperative administration gabapentin. Femoral nerve block (FNB) and intrathecal morphine (ITM) are seldom used alone for the management of postoperative pain, though they are known to provide excellent analgesia [5]. Since the recommendation by the PROSPECT working group [6], FNB and ITM have become two common methods for postoperative analgesia management following TKA

Methods

Results

Conclusion