Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: Intrathecal morphine significantly increased postoperative nausea and vomiting, pruritus, and urinary retention after surgery or labour in a dose-independent manner.
UNASSIGNED: PROSPERO (CRD42023387838).
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: Intrathecal morphine significantly increased postoperative nausea and vomiting, pruritus, and urinary retention after surgery or labour in a dose-independent manner.
UNASSIGNED: PROSPERO (CRD42023387838).
摘要：
背景：鞘内注射吗啡为一系列手术提供了有效的镇痛作用。然而,对潜在副作用的担忧阻碍了在临床实践中的广泛实施.我们进行了系统的审查，荟萃分析，和荟萃回归的主要目标是确定是否可以定义非肺部并发症的阈值剂量，以及在鞘内注射吗啡用于围手术期或产科镇痛时，剂量与并发症发生率之间是否可以建立关联。
方法：我们系统地检索了文献，以比较鞘内注射吗啡与对照组在全身麻醉或脊髓麻醉下接受任何类型手术的患者的随机对照试验。或妇女在劳动。主要结果是术后恶心和呕吐的发生率，瘙痒,术后24小时内尿潴留，根据剂量分析（1-100μg;101-200μg;201-500μg;>500μg），手术类型,和麻醉策略。如果未指定剂量，则排除试验。
结果：我们的分析包括168项试验，涉及9917名患者。术后恶心和呕吐的发生率，瘙痒,鞘内注射吗啡组尿潴留明显增加，比值比(95%置信区间)为1.52(1.29-1.79)，P<0.0001;6.11(5.25-7.10),P<0.0001；和1.73（1.17-2.56），P分别=0.005。Meta回归无法确定剂量与非肺部并发症发生率之间的关联。根据手术结果，没有亚组差异。证据质量低(建议评估分级，发展,和评估[等级]系统)。
结论：鞘内注射吗啡可显着增加术后恶心和呕吐，瘙痒,手术或分娩后的尿潴留与剂量无关。
■PROSPERO（CRD42023387838）。
方法：我们系统地检索了文献，以比较鞘内注射吗啡与对照组在全身麻醉或脊髓麻醉下接受任何类型手术的患者的随机对照试验。或妇女在劳动。主要结果是术后恶心和呕吐的发生率，瘙痒,术后24小时内尿潴留，根据剂量分析（1-100μg;101-200μg;201-500μg;>500μg），手术类型,和麻醉策略。如果未指定剂量，则排除试验。
结果：我们的分析包括168项试验，涉及9917名患者。术后恶心和呕吐的发生率，瘙痒,鞘内注射吗啡组尿潴留明显增加，比值比(95%置信区间)为1.52(1.29-1.79)，P<0.0001;6.11(5.25-7.10),P<0.0001；和1.73（1.17-2.56），P分别=0.005。Meta回归无法确定剂量与非肺部并发症发生率之间的关联。根据手术结果，没有亚组差异。证据质量低(建议评估分级，发展,和评估[等级]系统)。
结论：鞘内注射吗啡可显着增加术后恶心和呕吐，瘙痒,手术或分娩后的尿潴留与剂量无关。
■PROSPERO（CRD42023387838）。
