Table 4: Pre-operative spinal opioid versus control (spinal LA anaesthesia in both groups): study details and qualitative outcomes
Study | n treatment/ control | Comparison | Supplemental analgesic | VAS scores and type of pain, where specified | Time to first analgesic request | Use of supplemental analgesic | Other important outcomes |
(LoE 1) | 17/18 | On a background of spinal bupivacaine anaesthesia: spinal morphine (0.3 mg; 1 mg/ml) (Op) vs. saline (Cont) | Postop: oral or rectal diclofenac (50 mg every 8 h); PCA-morphine, IV | VAS on movement: Op superior at all time points recorded: 4 h (p<0.01), 12 h (p=0.01) and 24 h (p<0.05) | __ | PCA morphine: Op superior during the 1st 24 h postop (p<0.01) | Pain Number of patients reporting absent/mild pain: NS; patient satisfaction with analgesia: NS PONV Treated emesis: NS Respiratory function Respiratory distress indices: NS; median SpO2 (%): Op<Cont (p<0.05) Complications Pruritus, mild/moderate hypoxaemia: NS |
(LoE 1) | 19/21 | On a background of spinal bupivacaine anaesthesia: fentanyl (25 µg) (Op) vs. hyperbaric bupivacaine (12.5 mg) alone (Cont) | Postop: used, but no details given | VAS at time of first analgesic request: Op superior (p<0.001) (knee group) | N/A (knee and hip combined) | __ | Pain Facial expression test scores (1–8): Op superior (p<0.02) (knee group) PONV N/A (knee and hip combined) Complications N/A (knee and hip combined) |
(LoE 1) | 7/7/7/7/7 | On a background of spinal bupivacaine anaesthesia: 2.5 mg spinal diamorphine (A) vs. 1.5 mg spinal diamorphine (B) vs. 0.75 mg spinal diamorphine (C) vs. 0.25 mg spinal diamorphine (D) vs. 0 mg spinal diamorphine (NT) | Postop: IV morphine until adequate analgesia achieved; IM morphine, as required | NS at 2–22 h | Time to initial supplemental morphine: A, B, C and D superior (p<0.05, in all cases) | Supplemental morphine: NS | PONV NS Complications Pruritus: NT superior compared with A, B and C (p<0.05, in all cases); urinary retention: NS |
(LoE 1) | 20/21 | On a background of spinal bupivacaine anaesthesia: spinal morphine (250 µg) (Op) vs. saline (Cont) | Postop: PCA-morphine IV, as required; IV ketorolac (15–30 mg) every 6 h | Op superior at 1, 2 and 4 h (p<0.01, in all cases) and at 24 h (p<0.05), but not at 6 or 12 h | __ | Morphine consumption: Op superior at 2–4 h and 6–12 h (p<0.05, in both cases), but not at other time intervals (i.e. at 0–1 h, 1–2 h, 4–6 h, 12–24 h) | PONV NS (moderate-to-severe PONV) Complications Hypotension, pruritus, oxygen desaturations: NS |
(LoE 1) | 20/20 | On a background of spinal bupivacaine anaesthesia: spinal morphine 300 µg (Op) vs. 0.5 ml saline (Cont) | Postop: IM diclofenac (75 mg) if VAS>4 and every 12 h, as required | Op superior at 8 h (p<0.05); overall 24 h pain score: Op superior (p<0.05) | Duration of spinal analgesia: Op superior (p<0.05); time to first diclofenac request: Op superior (p<0.05) | Number of IM diclofenac doses: NS | PONV Nausea/vomiting: NS Complications Pruritus: Cont superior (p<0.05); dizziness: NS |