Non-pulmonary complications of intrathecal morphine administration: a systematic review and meta-analysis with meta-regression.

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Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_ED57613E0E68
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Non-pulmonary complications of intrathecal morphine administration: a systematic review and meta-analysis with meta-regression.
Journal
British journal of anaesthesia
Author(s)
Renard Y., El-Boghdadly K., Rossel J.B., Nguyen A., Jaques C., Albrecht E.
ISSN
1471-6771 (Electronic)
ISSN-L
0007-0912
Publication state
Published
Issued date
10/2024
Peer-reviewed
Oui
Volume
133
Number
4
Pages
823-838
Language
english
Notes
Publication types: Systematic Review ; Journal Article ; Meta-Analysis ; Review
Publication Status: ppublish
Abstract
Intrathecal morphine provides effective analgesia for a range of operations. However, widespread implementation into clinical practice is hampered by concerns for potential side-effects. We undertook a systematic review, meta-analysis, and meta-regression with the primary objective of determining whether a threshold dose for non-pulmonary complications could be defined and whether an association could be established between dose and complication rates when intrathecal morphine is administered for perioperative or obstetric analgesia.
We systematically searched the literature for randomised controlled trials comparing intrathecal morphine vs control in patients undergoing any type of surgery under general or spinal anaesthesia, or women in labour. Primary outcomes were rates of postoperative nausea and vomiting, pruritus, and urinary retention within the first 24 postoperative hours, analysed according to doses (1-100 μg; 101-200 μg; 201-500 μg; >500 μg), type of surgery, and anaesthetic strategy. Trials were excluded if doses were not specified.
Our analysis included 168 trials with 9917 patients. The rates of postoperative nausea and vomiting, pruritus, and urinary retention were significantly increased in the intrathecal morphine group, with an odds ratio (95% confidence interval) of 1.52 (1.29-1.79), P<0.0001; 6.11 (5.25-7.10), P<0.0001; and 1.73 (1.17-2.56), P=0.005, respectively. Meta-regression could not establish an association between dose and rates of non-pulmonary complications. There was no subgroup difference according to surgery for any outcome. The quality of evidence was low (Grading of Recommendations Assessment, Development, and Evaluation [GRADE] system).
Intrathecal morphine significantly increased postoperative nausea and vomiting, pruritus, and urinary retention after surgery or labour in a dose-independent manner.
PROSPERO (CRD42023387838).
Keywords
Humans, Morphine/administration & dosage, Morphine/adverse effects, Injections, Spinal, Pruritus/chemically induced, Analgesics, Opioid/administration & dosage, Analgesics, Opioid/adverse effects, Postoperative Nausea and Vomiting/epidemiology, Postoperative Nausea and Vomiting/chemically induced, Urinary Retention/chemically induced, Dose-Response Relationship, Drug, Randomized Controlled Trials as Topic, Female, Anesthesia, Spinal/adverse effects, Anesthesia, Spinal/methods, Postoperative Complications/chemically induced, Pain, Postoperative/drug therapy, intrathecal morphine, non-pulmonary complications, postoperative nausea and vomiting, pruritus, urinary retention
Pubmed
Web of science
Open Access
Yes
Create date
09/08/2024 15:15
Last modification date
08/10/2024 7:07
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