Efficacy and safety of intrathecal diamorphine: a systematic review and meta‐analysis with meta‐regression and trial sequential analysis
Pooled result · IV morphine consumptionResult — go to the resultMean difference −8 mg 95% CI −11 to −6Authors' conclusion
There is very low level of evidence that intrathecal diamorphine provides effective analgesia after surgery, while increasing postoperative nausea and vomiting with doses > 200 μg.
Study context
- Population
- Patients undergoing all types of surgery
- Participants
- 712 patients · 12 trials
- Comparison
- Intrathecal diamorphine vs control
- Outcome
- Efficacy: IV morphine consumption; safety: incidence of PONV
- Follow-up
- 24 h following surgery
Methodological detailsmeta-regression, trial sequential analysis, Quality of evidence for all outcomes very low
- Meta-regression
- Trial sequential analysis
- Quality of evidence for all outcomes very low
Pooled result
IV morphine consumption · 24 h postoperatively
Mean difference
−8 mg
95% CI −11 to −6
P < 0.001
Intrathecal diamorphine vs Control
mean difference −8 mg (95% CI −11 to −6); P < 0.001
As reported in the abstract
Further pooled results
| Outcome | Mean difference (mg) (95% CI) | |
|---|---|---|
| IV morphine consumption by dose subgroup (subgroup) · 24 h postoperatively0-200 μg vs Control | −1 (−3-0) | |
| IV morphine consumption by dose subgroup (subgroup) · 24 h postoperatively201-400 μg vs Control | −26 (−40 to −11) | |
| IV morphine consumption by dose subgroup (subgroup) · 24 h postoperatively> 400 μg vs Control | −6 (−15-4) | |
| −60−40−20020Difference, mg (linear scale) |
- IV morphine consumption by dose subgroup (subgroup): significant difference between subgroups (p = 0.003) but without correlation
Safety
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| PONV · 24 h following surgeryI2 = 7% · no correlation on meta-regression | 1.37 (1.19–1.58) | P < 0.001 | |
| 0.512Relative risk (log scale) |
PONV · 24 h following surgery
- No differences in PONV between the three dosing subgroups
Original publication
Efficacy and safety of intrathecal diamorphine: a systematic review and meta‐analysis with meta‐regression and trial sequential analysis. Anaesthesia. Published 23 June 2024. doi:10.
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