Skip Navigation

British Journal of Anaesthesia 2009 102(2):156-167; doi:10.1093/bja/aen368
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME/CE:
Take the course for this article:
 BJA: February 2009
Right arrow E-Letters: Submit a response to the article
Right arrow E-letters: View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Related articles in BJA
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Meylan, N.
Right arrow Articles by Tramèr, M. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Meylan, N.
Right arrow Articles by Tramèr, M. R.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?


© The Board of Management and Trustees of the British Journal of Anaesthesia 2009. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing major surgery: meta-analysis of randomized trials

N. Meylan1, N. Elia1,2, C. Lysakowski1 and M. R. Tramèr1,2,*

1 Division of Anaesthesiology, University Hospitals of Geneva, 24, rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland
2 Medical Faculty, University of Geneva, Geneva, Switzerland

* Corresponding author. E-mail: martin.tramer{at}hcuge.ch

Intrathecal morphine without local anaesthetic is often added to a general anaesthetic to prevent pain after major surgery. Quantification of benefit and harm and assessment of dose–response are needed. We performed a meta-analysis of randomized trials testing intrathecal morphine alone (without local anaesthetic) in adults undergoing major surgery under general anaesthesia. Twenty-seven studies (15 cardiac–thoracic, nine abdominal, and three spine surgery) were included; 645 patients received intrathecal morphine (dose-range, 100–4000 µg). Pain intensity at rest was decreased by 2 cm on the 10 cm visual analogue scale up to 4 h after operation and by about 1 cm at 12 and 24 h. Pain intensity on movement was decreased by 2 cm at 12 and 24 h. Opioid requirement was decreased intraoperatively, and up to 48 h after operation. Morphine-sparing at 24 h was significantly greater after abdominal surgery {weighted mean difference, –24.2 mg [95% confidence interval (CI) –29.5 to –19.0]}, compared with cardiac–thoracic surgery [–9.7 mg (95% CI –17.6 to –1.80)]. The incidence of respiratory depression was increased with intrathecal morphine [odds ratio (OR) 7.86 (95% CI 1.54–40.3)], as was the incidence of pruritus [OR 3.85 (95% CI 2.40–6.15)]. There was no evidence of linear dose-responsiveness for any of the beneficial or harmful outcomes. In conclusion, intrathecal morphine decreases pain intensity at rest and on movement up to 24 h after major surgery. Morphine-sparing is more pronounced after abdominal than after cardiac–thoracic surgery. Respiratory depression remains a major safety concern.

Keywords: anaesthetic techniques, subarachnoid; analgesia, postoperative; analgesic techniques, subarachnoid; analgesics opioid, morphine; complications, respiratory depression; pain, postoperative; meta-analysis


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?

Related articles in BJA:

In the February 2009 BJA ...

BJA 2009 102: NP. [Extract] [Full Text]  



E-letters:

Read all E-letters

Alternatives to Intrathecal Morphine
Clinton Z. Kakazu, MD, et al.
British Journal of Anaesthesia, 21 Apr 2009 [Full text]

Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.