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Review
. 2023 Dec 26;13(1):137.
doi: 10.3390/jcm13010137.

Intrathecal Morphine and Post-Operative Pain Relief in Robotic Surgeries: A Systematic Review and Meta-Analysis

Zi Heng Tee  1 , Erica Ho Ching Tsoi  1 , Quinston Lee  1 , Yen Sin Wong  1 , Arron Gibson  1 , Niamh Parsons  1 , Shafaque Shaikh  1   2 , Patrice Forget  1   3   4   5
Affiliations
Review

Intrathecal Morphine and Post-Operative Pain Relief in Robotic Surgeries: A Systematic Review and Meta-Analysis

Zi Heng Tee et al. J Clin Med. .

Abstract

Despite the potential benefits of intrathecal morphine (ITM), the precise role and dosing of ITM in robotic assisted surgery (RAS) remains unclear. This systematic review explores real-world evidence to evaluate the efficacy and outcomes of ITM in patients undergoing RAS. In accordance with PRISMA guidelines, a comprehensive search was conducted on four databases: MEDLINE, Embase, Cochrane Library and APA PsycInfo. Primary outcomes included pain scores at rest and on exertion at 24- and 48-h time intervals, and secondary outcomes aimed to explore the side effects of ITM. A meta-analysis was conducted to determine mean differences. A risk of bias assessment was conducted via the Cochrane Risk of Bias 2 tool. A total of 9 RCTs involving 619 patients were included in this review, of which 298 patients were administered ITM. Significant pain score reductions were observed both at rest (MD = -27.15; 95% CI [-43.97, -10.33]; I2 = 95%; p = 0.002) and on exertion (MD = -25.88; 95% CI [-37.03, -14.72]; I2 = 79%; p = 0.0003) 24 h postoperatively in the ITM groups, accompanied by a notable decrease in postoperative IV morphine equivalent consumption at 24 h (MD = -20.13; 95% CI [-30.74, -9.52]; I2 = 77%; p = 0.0002). ITM improved pain scores both at rest and on exertion at 24 and 48 h intervals, concurrently reducing the need for postoperative opioid consumption, but at the cost of an increased incidence of adverse events.

Keywords: intrathecal morphine; post-operative outcomes; robotic surgery.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of included studies [35].
Figure 2
Figure 2
Pain scores at rest after postoperative ITM at 24 h [27,29,32,33,34].
Figure 3
Figure 3
Pain scores on exertion after postoperative ITM at 24 h [9,27,29,32,33,34].
Figure 4
Figure 4
Postoperative consumption of equivalent IV morphine consumption at 24 h [27,29,34].
Figure 5
Figure 5
Secondary outcomes of included studies at 24 h [31,33,34].
Figure 6
Figure 6
Cochrane Rob2 risk of bias assessment summary [9,27,28,29,30,31,32,33,34].
See this image and copyright information in PMC

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