Abstract:
Objective To compare the efficacy and safety of intra-articular (IA)and intra-epidural(IE) analgesia by morphine after arthroscopic knee surgery.
Methods A literature search was conducted in PubMed, Excerpta Medica Database(Embase)、WANFANG Data and China National Knowledge Infrastructure (CNKI). Further searches for articles were conducted by checking all references describing IA and IE analgesia after arthroscopic knee surgery. The trials containing other formulated anesthetic drugs, or inclusion of patients suffering from mental illness, preoperative use of sedative and analgesic drugs were excluded. The finally included studies were identified, methodological qualities were assessed and data were extracted. The homogeneous studies were pooled using RevMan 5.2 software.
Results Six randomized controlled trials (RCTs) involving 319 patients(159 cases of IA, 160 cases of IE)met the inclusion criteria. There was no significant difference in visual analogue scale (VAS) of pain perception between IA and IE group at 8 h and 24 h postoperatively [weighted mean difference(WMD)=-0.01, 95%CI(-0.16, 0.14), P=0.89; 24h: WMD=-0.25, 95%CI(-0.54, 0.03), P=0.08]. The IA morphine significantly resulted in lower incidence of adverse events than IE analgesia [nausea and vomiting: odds ratio(OR)=0.11, 95%CI(0.02, 0.48), P=0.003; pruritus, OR=0.11, 95%CI(0.03, 0.37), P=0.0003; urinary retention, OR=0.07, 95%CI(0.02, 0.25), P<0.0001]. Subgroup analysis suggested the influences of dose of morphine on the above results were not statically significant.
Conclusion IA morphine could achieve comparable VAS after arthroscopic knee surgery but IA morphine dramatically reduce risk of side effects compared to IE.
Key words:
Analgesia,
Morphine,
Knee joint,
Meta-analysis
Hui Pang, Xiaolin Cai, Xinxin Zhang, Tiao Lin. Meta-analysis on intra-articular and intra-epidural analgesia following arthroscopic knee surgery[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(05): 572-577.