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Teunissen AJW, van Gastel L, Stolker RJ, Koopman SA. The use of intrathecal morphine in non-abdominal surgery: a scoping review. BJA OPEN 2025; 14:100387. [PMID: 40223919 PMCID: PMC11987639 DOI: 10.1016/j.bjao.2025.100387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Accepted: 02/07/2025] [Indexed: 04/15/2025]
Abstract
Background Intrathecal morphine can reduce pain and opioid requirements needed for postoperative pain relief. It can potentially aid in the effectiveness of enhanced recovery protocols in non-abdominal surgery. However, concerns about side-effects may have hindered its use. This scoping review evaluates the effectiveness, appropriate dosage, and adverse effects of intrathecal morphine in non-abdominal surgery. Methods We systematically searched for randomised controlled trials examining the use of intrathecal morphine in non-abdominal surgery. Results The search identified 75 trials involving 4685 patients. We undertook a scoping review of these randomised controlled trials, including bias assessments, to comprehensively analyse the effectiveness and side-effects of intrathecal morphine. The findings indicate that intrathecal morphine reduced postoperative pain and opioid consumption after spinal surgery, thoracic surgery, and orthopaedic lower extremity surgery. However, it was associated with an increased incidence of itching, postoperative nausea and vomiting, and urinary retention, particularly in orthopaedic procedures. Delayed respiratory depression was absent with low to moderate doses (<500 μg) in the reviewed studies. Conclusions This review supports the effectiveness of intrathecal morphine in non-abdominal surgery. However, the benefits must be carefully weighed against potential side-effects that could lead to prolonged hospital stays. Clinical trial registration PROSPERO-registry CRD42021233936.
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Affiliation(s)
- Aart Jan W. Teunissen
- Maasstad Hospital, Anaesthesiology, Rotterdam, the Netherlands
- Erasmus Medical Centre, University Medical Centre Rotterdam, the Netherlands
| | - Lieke van Gastel
- Erasmus Medical Centre, University Medical Centre Rotterdam, the Netherlands
| | - Robert J. Stolker
- Erasmus Medical Centre, University Medical Centre Rotterdam, the Netherlands
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Zhao C, Liao Q, Yang D, Yang M, Xu P. Advances in perioperative pain management for total knee arthroplasty: a review of multimodal analgesic approaches. J Orthop Surg Res 2024; 19:843. [PMID: 39696522 DOI: 10.1186/s13018-024-05324-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Accepted: 11/29/2024] [Indexed: 12/20/2024] Open
Abstract
Despite significant advancements in total knee arthroplasty (TKA), managing postoperative pain remains a substantial clinical challenge. With advances in surgical techniques and pharmacology, TKA perioperative analgesic strategies continue to evolve, necessitating ongoing reassessment of current data. Multimodal analgesia has become the standard for perioperative pain management in TKA; however, variations in its specific components and applications across studies create challenges in selecting the optimal analgesic approach. Evaluating these pain management strategies is essential for understanding their benefits, limitations, and appropriate use, allowing the development of individualized perioperative analgesic plans. This review aims to summarize current research on perioperative pain control in TKA and assess the effectiveness of different analgesic interventions.
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Affiliation(s)
- Chengcheng Zhao
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, China
| | - Qimeng Liao
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Dinglong Yang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, China
| | - Mingyi Yang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, China.
| | - Peng Xu
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, China.
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Van Egmond JC, De Esch NHH, Verburg H, Van Dasselaar NT, Mathijssen NMC. Preoperative carbohydrate drink in fast-track primary total knee arthroplasty: a randomized controlled trial of 168 patients. Acta Orthop Belg 2023; 89:485-490. [PMID: 37935233 DOI: 10.52628/89.3.11930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
A key component in fast-track total knee arthroplasty (TKA) is early mobilization. Preoperative fasting might cause orthostatic hypotension and -intolerance which both can interfere with early mobilization. It was hypothesized that consuming a carbohydrate drink 2-3 hours prior to surgery is a viable option to reduce orthostatic hypotension, and as a result, improve rehabilitation. In this randomized controlled trial, all consecutive unilateral primary TKA patients were reviewed for eligibility. Exclusion criteria were American Society of Anesthesiologists (ASA) class above 3, older than 80 years of age, Diabetes Mellitus, and an insufficient comment of Dutch language. Patients were distributed in two groups. The control group was allowed to eat till 6 hours and drink clear fluids till 2 hours before surgery (standard treatment). The intervention group consumed, additionally to the standard treatment, a carbohydrate drink 2-3 hours before surgery. Blood pressure was measured both lying and standing as a measure for orthostatic hypotension during first time postoperative mobilization on day of surgery. A total of 168 patients were included. Prevalence of orthostatic hypotension in the control- and intervention group was 24 patients (34%) and 14 patients (19%) respectively, (p=0.05). Prevalence of orthostatic intolerance was 13 patients (19%) in the control group and 9 patients (13%) in the intervention group (p=0.32). No drink related adverse events occurred. In conclusion, taking a carbohydrate drink 2-3 hours before TKA significantly lowers the number of patients with orthostatic hypotension in early mobilization. However, the clinical relevance of the carbohydrate drink has to be studied further.
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Kukreja P, Streetzel C, Short RT, Mabry SE, Feinstein J, Brazeel K, Cerice D, Chapman L, Kalagara H. Intrathecal Morphine Use Improves Postoperative Analgesia and Reduces Opioid Consumption in Patients Undergoing Total Knee Arthroplasty Under Spinal Anesthesia: A Retrospective Study. Cureus 2023; 15:e43039. [PMID: 37674945 PMCID: PMC10479995 DOI: 10.7759/cureus.43039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 09/08/2023] Open
Abstract
Background Intrathecal morphine (ITM) provides effective postoperative analgesia for patients undergoing total knee arthroplasty (TKA) under spinal anesthesia (SA). The management of pain in patients undergoing TKA has remained a challenge for anesthesiologists, as no single regional anesthesia technique is adequate with regard to balancing effective analgesia with minimal side effects. Severe postoperative pain following TKA has been shown to negatively impact patient outcomes and mortality. This study is aimed to describe the effect of intrathecal morphine in patients undergoing total knee arthroplasty. Methods This was a retrospective, descriptive, and single-center study conducted on patients undergoing total knee arthroplasty from June 1, 2022, to June 1, 2023. The sample size consisted of 50 patients who were 18 years and older, American Society of Anesthesiology (ASA) class 1-3, and patients who had received either 150 mcg (experimental) or no ITM dose under spinal anesthesia. Oral morphine requirement (OME) and visual analog pain scale (VAS) were used to assess pain in the first 24 hours after surgery. Results The experimental group had significantly lower OME usage in the post-anesthesia care unit (PACU) (p < 0.001) and at six hours (p = 0.040) postoperatively. At 12 hours and 24 hours postoperatively, the two groups had similar OME use (p > 0.20, for both). The experimental group had significantly less total OME use over the first 24-hour postoperative period. The experimental group had significantly lower pain scores in the PACU (p < 0.001) and at six hours postop (p = 0.002); there were no significant differences between groups at 12- and 24-hours postop. The ambulation distance was clinically significant and better in the ITM group but was not statistically significant (p = 0.080). There was no difference between groups in the incidence of postoperative nausea and vomiting (PONV). Conclusion The careful use of ITM with the optimal dose offers an effective addition to regional anesthesia for improved analgesia with minimal side effects. The 150 mcg ITM dose provided good analgesic effects with longer duration and was not associated with respiratory depression.
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Affiliation(s)
- Promil Kukreja
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Charlotte Streetzel
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Roland T Short
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Scott E Mabry
- Orthopaedics, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Joel Feinstein
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Kathy Brazeel
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Diana Cerice
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Luanne Chapman
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Hari Kalagara
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, USA
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Hong C, Xie HY, Ge WK, Yu M, Lin SN, Liu CJ. The efficacy of parecoxib in improving pain after total knee or total hip arthroplasty: Systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30748. [PMID: 36197263 PMCID: PMC9509050 DOI: 10.1097/md.0000000000030748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The cyclooxygenase-2 (COX-2) selective inhibitor parecoxib is widely used in the treatment of pain and inflammation. Parecoxib has been adopted for use for postoperative analgesia following a range of surgical procedures (orthopedic, general, gynecological, and dental surgery). Total knee or total hip arthroplasty (THA) surgery is mostly done in older patients, so postoperative analgesics need to be used more carefully, and the safety and efficacy of parecoxib in this type of surgery need to be further verified. The aim of this study was to investigate the effects of parecoxib on patient safety, cumulative morphine consumption and was at 24 and 48 hours in the analgesic treatment of total knee or THA for meta-analysis and systematic review, with few studies in this area so far. METHODS We searched the Online Database Cochrane Library, PubMed, Web of Science, EMBASE, and CBM (SinoMed), CNKI, VIP, WANFANG up to January 2021. According to the value of I2, the random-effect model or fixed-effect model was supposed to combine data from studies, respectively. Publication bias was assessed through funneling plot and Beggs test. Review Manager 5.3 and Stata 16.0 software were applied to perform the statistical analyses. RESULTS Eleven RCTs which involved 1690 participants were included in this study. The meta-analysis indicated parecoxib sodium could not significantly reduce the incidence of adverse events after total knee or THA compared with placebo. There was no statistical significance in incidence of nausea and vomiting. 24 hours resting VAS score was statistically significant between the group. The 48-hour resting VAS scores did not indicate a significant difference between the groups. CONCLUSION Parecoxib can reduce the incidence of adverse events after total knee or total hip surgery to some extent but cannot reduce the incidence of nausea and vomiting. Twenty-four hour postoperative analgesia is better than placebo, but 48 hours after operation analgesia is the same as placebo.
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Affiliation(s)
- Chuan Hong
- Department of Orthopedics, Ninghai First Hospital, Ningbo, Zhejiang, China
| | - Hai-Yan Xie
- Department of Pharmacy, The Third Hospital of Quzhou, Zhejiang, China
| | - Wu-Kun Ge
- Department of Pharmacy, Ninghai First Hospital, Ningbo, Zhejiang, China
- * Correspondence: Wu-Kun Ge, Department of Pharmacy, Ninghai First Hospital, No. 142, Taoyuan Middle Road, Ninghai County, Ningbo City, Zhejiang Province, China (e-mail: )
| | - Min Yu
- Department of Pharmacy, Ninghai First Hospital, Ningbo, Zhejiang, China
| | - Shuai-nan Lin
- Department of Pharmacy, Ninghai First Hospital, Ningbo, Zhejiang, China
| | - Cheng-Jiang Liu
- Department of General Medicine, Affiliated Anqing First People’s Hospital of Anhui Medical University, Anhui, China
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Alghamdi BS, Alshehri FS. Melatonin Blocks Morphine-Induced Place Preference: Involvement of GLT-1, NF-κB, BDNF, and CREB in the Nucleus Accumbens. Front Behav Neurosci 2021; 15:762297. [PMID: 34720901 PMCID: PMC8551802 DOI: 10.3389/fnbeh.2021.762297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 09/28/2021] [Indexed: 12/27/2022] Open
Abstract
Opioid addiction remains a widespread issue despite continuous attempts by the FDA to help maintain abstinence. Melatonin is a neurohormone considered to be involved only in the neuroendocrine and reproductive systems; however, recent reports have demonstrated its potential to attenuate drug addiction and dependence. Cumulative studies have suggested that melatonin can attenuate the rewarding effects of several drugs of abuse, including opioids. This study aimed to investigate the effect of melatonin (50 mg/kg) on morphine (5 mg/kg) to produce place preference. We also investigated the effect of melatonin and morphine on the expression of GLT-1, BDNF, NF-κB, and CREB within the nucleus accumbens. Male Wistar rats were divided into control, morphine, melatonin, and the morphine + melatonin groups. The study involved a two-phase habituation phase from day 1 to day 3 and an acquisition phase from day 5 to day 14. The conditioned place preference (CPP) score, distance traveled, resting time, ambulatory count, and total activity count were measured for all animals. Rats that received morphine showed a significant increase in CPP score compared to those in the control group. Morphine treatment reduced the mRNA expression of GLT-1, BDNF, and CREB and increased that of NF-κB. However, melatonin treatment administered 30 min before morphine treatment attenuated morphine place preference and reversed GLT-1, BDNF, NF-κB, and CREB expression levels. In conclusion, the study results indicate, for the first time, the new potential targets of melatonin in modulating morphine-induced CPP.
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Affiliation(s)
- Badrah S Alghamdi
- Department of Physiology, Neuroscience Unit, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.,Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fahad S Alshehri
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
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Qi BC, Yu J, Qiao WS. Comparison of intrathecal morphine versus local infiltration analgesia for pain control in total knee and hip arthroplasty: A meta-analysis. Medicine (Baltimore) 2020; 99:e21971. [PMID: 32899035 PMCID: PMC7478411 DOI: 10.1097/md.0000000000021971] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The purpose of this meta-analysis was to comprehensively collect randomized controlled trials (RCTs) to assess the clinical efficacy of intrathecal morphine (ITM) versus local infiltration analgesia (LIA) in the treatment of total knee and hip arthroplasty patients. METHODS Relevant studies were identified from the Embase, PubMed, Cochrane Library, Web of Science, Wanfang, and Chinese National Knowledge Infrastructure (CNKI) databases. We also reviewed the references of all identified articles to identify additional studies. For each study, we assessed the risk ratio (RR), weighted mean difference (WMD), and corresponding 95% confidence interval (95% CI) to synthesize outcomes. Meta-analysis was performed with Stata 12.0 software. RESULTS We included 13 studies with 942 patients for meta-analysis. LIA significantly decreased the pain value with rest or mobilization until 72 hours (P < .05). LIA significantly decreased cumulative morphine consumption by 13.52 mg. Moreover, the length of hospital stay was lower in the LIA group than in the ITM analgesia group. Finally, LIA significantly reduced morphine-related complications (nausea and vomiting, pruritus, and respiration depression). CONCLUSIONS LIA was an effective approach for relieving postoperative pain and reducing postoperative consumption of morphine compared with ITM in total knee and hip arthroplasty patients.
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Affiliation(s)
- Bao-chang Qi
- Department of Orthopedic Traumatology, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Jing Yu
- Department of The First Operating Room, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Wei-song Qiao
- Department of Orthopedic Traumatology, the First Hospital of Jilin University, Changchun, Jilin, China
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Peng XQ, Fei ZG, Sun CG, Zhou QJ. Efficacy and safety of local infiltration analgesia for pain management in total knee and hip arthroplasty: A meta-analysis of randomized controlled trial. Medicine (Baltimore) 2020; 99:e20640. [PMID: 32481477 DOI: 10.1097/md.0000000000020640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Local infiltration analgesia (LIA) has become popular in postoperative pain relief after total hip arthroplasty (THA) or total knee arthroplasty (TKA). The aim of this meta-analysis was to compare the efficacy and safety of LIA with intrathecal morphine and epidural analgesia after THA and TKA. METHODS A systematic article search was performed from PubMed, Embase, and Web of Science databases, up to February 21, 2019. The main outcomes included visual analog scale for assessment of pain, morphine equivalent consumption, length of hospital stay, and adverse events. The data were calculated using weight mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (95% CIs). RESULTS Eleven studies with a total of 707 patients met the inclusion criteria and were included in this meta-analysis. LIA provided better pain control than other 2 techniques at 24-hour (WMD = 10.61, 95% CI: 3.36-17.87; P = .004), 48-hour (WMD = 16.0, 95% CI: 8.87-23.13; P < .001), and 72-hour (WMD = 11.31, 95% CI: 3.78-18.83; P < .001). Moreover, LIA had similar morphine consumption and duration of hospital stay with intrathecal morphine and epidural analgesia. There was significantly lower incidence of adverse events with LIA than with the other 2 techniques. CONCLUSION LIA provided better postoperative pain control and less adverse events than intrathecal morphine and epidural analgesia after THA and TKA.
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Affiliation(s)
- Xiao-Qiang Peng
- Department of Orthopaedics, Funing People's Hospital, Jiangsu Province, China
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Cai AL, Liu SJ, Wu B, Liu G. Intrathecal versus local infiltration analgesia for pain control in total joint arthroplasty. J Orthop Surg Res 2020; 15:110. [PMID: 32188483 PMCID: PMC7079456 DOI: 10.1186/s13018-020-01627-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this meta-analysis was to assess the efficacy of intrathecal morphine (ITM) analgesia and local infiltration analgesia (LIA) for pain control in total joint arthroplasty (TJA). METHODS Embase, PubMed, the Cochrane Library, and Web of Science were systematically searched for randomized controlled trials (RCTs). All RCTs were comparing intrathecal analgesia and local infiltration analgesia in TJA. Primary outcomes were the visual analog scale (VAS) score with rest or mobilization up to 72 h. Secondary outcomes were the total morphine consumption, length of hospital stay, and morphine-related complications. RESULTS Compared with the intrathecal analgesia group, the LIA group was associated with a reduction in VAS score with rest up to 72 h. Moreover, LIA was associated with a decrease in VAS score with mobilization at 6 h, 12 h, 48 h, and 72 h. Moreover, LIA significantly reduced total morphine consumption (weighted mean difference (WMD) = - 15.37, 95% CI - 22.64 to - 8.83, P = 0.000), length of hospital stay (WMD = - 1.39, 95% CI - 1.67 to - 1.11, P = 0.000), and morphine-related complications (nausea and pruritus). CONCLUSIONS Local infiltration provided superior analgesia and morphine-sparing effects within the first 72 h compared with ITM following TJA.
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Affiliation(s)
- Ai-Lan Cai
- Anesthesiology Department, Liaocheng People's Hospital, No.67 DongChang West Road, Liaocheng, 252000, Shandong, China
| | - Sheng-Jie Liu
- Anesthesiology Department, Liaocheng People's Hospital, No.67 DongChang West Road, Liaocheng, 252000, Shandong, China
| | - Bin Wu
- Anesthesiology Department, Liaocheng People's Hospital, No.67 DongChang West Road, Liaocheng, 252000, Shandong, China
| | - Geng Liu
- Anesthesiology Department, Liaocheng People's Hospital, No.67 DongChang West Road, Liaocheng, 252000, Shandong, China.
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Metesky JL, Chen J, Rosenblatt M. Enhanced recovery after surgery pathway: The use of fascia iliaca blocks causes delayed ambulation after total hip arthroplasty. World J Anesthesiol 2019; 8:13-18. [DOI: 10.5313/wja.v8.i2.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/07/2019] [Accepted: 03/25/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fascia iliaca compartment blocks (FIBs) have been used to provide postoperative analgesia after total hip arthroplasty (THA). However, evidence of their efficacy remains limited. While pain control appears to be satisfactory, quadriceps weakness may be an untoward consequence of the block. Prior studies have shown femoral nerve blocks and fascia iliaca blocks as being superior for pain control and ambulation following THA when compared to standard therapy of parenteral pain control. However, most studies allowed patients to ambulate on post-operative day (POD) 2-3, whereas new guidelines suggest ambulation on POD 0 is beneficial.
AIM To determine the effect of FIB after THA in patients participating in an enhanced recovery after surgery (ERAS) program.
METHODS We conducted a retrospective analysis of patients undergoing THA with or without FICBs and their ability to ambulate on POD 0 in accordance with ERAS protocol. Perioperative data was collected on 39 patients who underwent THA. Demographic data, anesthesia data, and ambulatory outcomes were compared.
RESULTS Twenty patients had FIBs placed at the conclusion of the procedure, while 19 did not receive a block. Of the 20 patients with FIB, only 1 patient was able to ambulate. Of the 19 patients without FIB blocks, 17 were able to ambulate. All patients worked with physical therapy 2 h after arriving in the post-anesthesia care unit on POD 0.
CONCLUSION Our data suggests an association between FIB and delayed ambulation in the immediate post-operative period.
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Affiliation(s)
- Jamie-Lee Metesky
- Anesthesia Department, Mount Sinai St. Luke’s and West Hospitals, New york, NY 10019, United States
| | - Junping Chen
- Anesthesia Department, Mount Sinai St. Luke’s and West Hospitals, New york, NY 10019, United States
| | - Meg Rosenblatt
- Anesthesia Department, Mount Sinai St. Luke’s and West Hospitals, New york, NY 10019, United States
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A comparison of the analgesic efficacy of local infiltration analgesia vs. intrathecal morphine after total knee replacement. Eur J Anaesthesiol 2019; 36:264-271. [DOI: 10.1097/eja.0000000000000943] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Sah AP, Liang K, Sclafani JA. Optimal Multimodal Analgesia Treatment Recommendations for Total Joint Arthroplasty. JBJS Rev 2018; 6:e7. [DOI: 10.2106/jbjs.rvw.17.00137] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Optimal dose of intrathecal isobaric bupivacaine in total knee arthroplasty. Can J Anaesth 2018; 65:1004-1011. [DOI: 10.1007/s12630-018-1165-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/11/2018] [Accepted: 04/18/2018] [Indexed: 10/14/2022] Open
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Li X, Sun Z, Han C, He L, Wang B. A systematic review and meta-analysis of intravenous glucocorticoids for acute pain following total hip arthroplasty. Medicine (Baltimore) 2017; 96:e6872. [PMID: 28489787 PMCID: PMC5428621 DOI: 10.1097/md.0000000000006872] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/31/2017] [Accepted: 04/07/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Glucocorticoids are increasingly used perioperatively, principally to prevent postoperative nausea and vomiting (PONV), and acute postoperative pain following total hip arthroplasty (THA). The authors hypothesized that preoperative intravenous glucocorticoids is associated with less pain scores and PONV without increasing the complications after THA. METHODS Four databases (PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science) were searched with the limitations of randomized controlled trials (RCTs). The search cutoff date was set at November 6, 2016. Participants were patients who were prepared for primary THA. Intervention was preoperative intravenous glucocorticoids for postoperative pain control. Outcomes including the visual analog scale (VAS) scores at the postanesthesia care unit (PACU) and at 24 and 48 hours post operation, the occurrence of PONV and total morphine consumption were recorded. We calculated risk ratio (RR) with a 95% confidence interval (CI) for dichotomous outcomes, and the weighted mean difference (WMD) with a 95% CI for continuous outcomes. RESULTS A total of 6 studies were evaluated, which included 297 patients who underwent hip surgery with intravenous glucocorticoid treatment and control patients who underwent hip surgery without glucocorticoid treatment. Pooled results indicated that intravenous glucocorticoid treatment was associated with a reduction of VAS scores at the PACU (WMD = -9.06, 95% CI -12.67 to -5.45, P = .000) and total morphine consumption by 15.68 mg (WMD = -15.68, 95% CI -24.60 to -6.75, P = .001). No significant difference was observed in the VAS scores at 24 and 48 hours between the intravenous glucocorticoid and placebo treatments. Intravenous steroids can decrease the occurrence of PONV (RR = 0.46, 95% CI 0.26-0.82, P = .029). CONCLUSION Intravenous glucocorticoid treatment can decrease early pain intensity and PONV after THA. However, the evidence for the use of glucocorticoids is limited by the low number of studies and variation in dosing regimens. Thus, additional high-quality RCTs are needed to identify the optimal drug protocol and determine the safety of intravenous glucocorticoids.
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Affiliation(s)
- Xiuhua Li
- Department of Anesthesiology, Weifang Medical University
| | - Zheng Sun
- Department of Pathology, Affiliated Hospital of Weifang Medical University
| | - Chengbing Han
- Department of Oral and Maxillofacial Surgery, Weifang People's Hospital, Weifang
| | | | - Baoguo Wang
- Department of Anesthesiology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China
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