Intrathecal morphine provides better postoperative analgesia than psoas compartment block after primary hip arthroplasty

Souron, Vincent; Delaunay, Laurent; Schifrine, P.

doi:10.1007/bf03018643

Cited by 47 publications

(37 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3). In addition to the RCTs included in the two pairwise meta-analyses, Bayesian network meta-analysis included 10 more RCTs [3,12,14,19,32,45,48,53,55,61] comparing use of local infiltration analgesia or peripheral nerve blocks with epidural analgesia or intrathecal morphine. By introducing the additional indirect comparisons (epidural analgesia, intrathecal morphine) we increased the power and precision of the network meta-analysis (Appendix 1.…”

Section: Discussionmentioning

confidence: 99%

Is Local Infiltration Analgesia Superior to Peripheral Nerve Blockade for Pain Management After THA: A Network Meta-analysis

Jiménez-Almonte

Wyles

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Local infiltration analgesia and peripheral nerve blocks are common methods for pain management in patients after THA but direct head-to-head, randomized controlled trials (RCTs) have not been performed. A network meta-analysis allows indirect comparison of individual treatments relative to a common comparator; in this case placebo (or no intervention), epidural analgesia, and intrathecal morphine, yielding an estimate of comparative efficacy. Questions/purposes We asked, when compared with a placebo, (1) does use of local infiltration analgesia reduce patient pain scores and opioid consumption, (2) does use of peripheral nerve blocks reduce patient pain scores and opioid consumption, and (3) is local infiltration analgesia favored over peripheral nerve blocks for postoperative pain management after THA? Methods We searched six databases, from inception through June 30, 2014, to identify RCTs comparing local infiltration analgesia or peripheral nerve block use in patients after THA. A total of 35 RCTs at low risk of bias based on the recommended Cochrane Collaboration risk assessment tool were included in the network meta-analysis (2296 patients). Primary outcomes for this review were patient pain scores at rest and cumulative opioid consumption, both assessed at 24 hours after THA. Because of substantial heterogeneity (variation of outcomes between studies) across included trials, a random effect model for meta-analysis was used to estimate the weighted mean difference (WMD) and 95% CI. The gray literature was searched with the same inclusion criteria as published One of the authors certifies that he (RJS), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000-USD 100,000, from Biomet Inc (Warsaw, IN, USA 123Clin Orthop Relat Res (2016) 474:495-516 DOI 10.1007 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® trials. Only one unpublished trial (published abstract) fulfilled our criteria and was included in this review. All other studies included in this systematic review were full published articles. Bayesian network meta-analysis included all RCTs that compared local infiltration analgesia or peripheral nerve blocks with placebo (or no intervention), epidural analgesia, and intrathecal morphine. Results Compared with placebo, local infiltration analgesia reduced patient pain scores (WMD, À0.61; 95% CI, À0.97 to À0.24; p = 0.001) and opioid consumption (WMD, À7.16 mg; 95% CI, À11.98 to À2.35; p = 0.004). Peripheral nerve blocks did not result in lower pain scores or reduced opioid consumption compared with placebo (WMD, À0.43; 95% CI, À0.99 to 0.12; p = 0.12 and WMD, À3.14 mg, 95% CI, À11.30 to 5.02; p = 0.45). However, network meta-analysis comparing local infiltration analgesia with peripheral nerve blocks through common comparators showed no differences between postoperative pain scores (WMD, À0.36; 95% CI, À1.06 to 0.31) and opioid consumption (WMD, À4....

show abstract

Section: Discussionmentioning

confidence: 99%

Is Local Infiltration Analgesia Superior to Peripheral Nerve Blockade for Pain Management After THA: A Network Meta-analysis

Jiménez-Almonte

Wyles

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…8,[10][11][12][13] However, there is limited and contradictory evidence addressing the link between intrathecal morphine (ITM) and the development of retention following lower limb arthroplasty. Studies report both an increased incidence of retention with ITM [14][15][16][17] and no significant difference 18,19 when compared with other analgesic techniques. Some studies assessing the side effects of ITM do not include retention in their outcomes, often owing to the practice of intraoperative urethral catheterisation.…”

mentioning

confidence: 99%

The incidence of postoperative urinary retention in patients undergoing elective hip and knee arthroplasty

Fernandez

Karthikeyan

Wyse

et al. 2014

annals

View full text Add to dashboard Cite

INTRODUCTION Postoperative urinary retention requiring urethral catheterisation increases the risk of joint sepsis following arthroplasty. Spinal anaesthesia with opiate administration is used widely in lower limb arthroplasty. We sought to establish whether the choice of opiate agent had any effect on the incidence of postoperative retention and therefore the risk of joint sepsis. METHODS A total of 445 consecutive patients who underwent primary elective lower limb arthroplasty were reviewed retrospectively. Patients had general anaesthesia and femoral nerve block (GA+FNB), spinal anaesthesia and intrathecal fentanyl (SA+ITF) or spinal anaesthesia and intrathecal morphine (SA+ITM). RESULTS Urinary retention was observed in 14% of male and 2% of female patients with GA+FNB, 9% of male and 3% of female patients with SA+ITF, and 60% of male (p=0.0005) and 5% of female patients with SA+ITM. Men who experienced retention were older (68 vs 64 years, p=0.013) and had longer inpatient stays (6.7 vs 4.6 days, p=0.043). Fewer patients in the SA+ITM group required breakthrough analgesia (28% vs 58%, p=0.004). CONCUSIONS The use of ITM in men significantly increases the incidence of urinary retention requiring urethral catheterisation and subsequently increases the risk of deep joint sepsis. Its use should be rationalised against the intended benefits and alternatives sought where possible.

show abstract

“…Possible reasons for failure to find a difference with respect to potential side effects is the relatively small difference in opiate consumption between the two groups and failure of this difference to be sustained beyond 12 hours. An alternative possibility for not finding a difference is that the potential complications related to morphine use are more commonly associated with the use of spinal morphine [22], an approach to pain control not used in this study. We acknowledge that failure to find a reduction in opiaterelated side effects limits the clinical importance of the reduction in postoperative opiate use in the treatment group.…”

Section: Discussionmentioning

confidence: 99%

Can a Periarticular Levobupivacaine Injection Reduce Postoperative Opiate Consumption During Primary Hip Arthroplasty?

Murphy

Byrne

Curtin

et al. 2012

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Several reports have confirmed the ability of intraoperative periarticular injections to control pain after THA. However, these studies used differing combinations of analgesic agents and the contribution of each, including the local anesthetic agent, is uncertain. Understanding the independent effects of the various agents could assist in improved pain management after surgery. Questions/purposes We therefore determined the ability of intraoperative periarticular infiltration of levobupivacaine to (1) reduce postoperative pain, (2) reduce postoperative morphine requirements, and (3) reduce the incidence of nausea and urinary retention. Patients and Methods A double-blinded, randomized, placebo-controlled trial of patients undergoing primary THAs was performed. Patients were randomized to receive a periarticular infiltration of 150 mg levobupivacaine in 60 mL 0.9% saline (n = 45) or a placebo consisting of 60 mL 0.9% saline (n = 46). We obtained a short-form McGill pain score, visual analog scale (VAS), and morphine requirements via patient-controlled analgesia (PCA) as primary measures. Postoperative antiemetic requirements and need for catheterization for urinary retention were determined as secondary measures. Results Subjectively reported pain scores and the overall intensity scores were similar for both groups in the postoperative period. At the same time the mean morphine consumption was less in the levobupivacaine group, most notable in the first 12 hours after surgery: treatment group 11.5 mg vs control group 21.2 mg. We observed no differences in the frequency of postoperative nausea and vomiting or urinary retention. Conclusions Our observations suggest periarticular injection of levobupivacaine can supplement available postoperative analgesic techniques and reduce postoperative morphine requirements after THA.

show abstract

Intrathecal morphine provides better postoperative analgesia than psoas compartment block after primary hip arthroplasty

Abstract: 0.1 mg intrathecal morphine administration provides better postoperative analgesia than single-shot psoas compartment block after primary hip arthroplasty.

Cited by 47 publications

References 26 publications

Is Local Infiltration Analgesia Superior to Peripheral Nerve Blockade for Pain Management After THA: A Network Meta-analysis

Is Local Infiltration Analgesia Superior to Peripheral Nerve Blockade for Pain Management After THA: A Network Meta-analysis

The incidence of postoperative urinary retention in patients undergoing elective hip and knee arthroplasty

Can a Periarticular Levobupivacaine Injection Reduce Postoperative Opiate Consumption During Primary Hip Arthroplasty?

Contact Info

Product

Resources

About