The purpose of this meta-analysis was to assess the efficacy of intrathecal morphine (ITM) analgesia and local infiltration analgesia (LIA) for pain control in total joint arthroplasty (TJA). Embase, PubMed, the Cochrane Library, and Web of Science were systematically searched for randomized controlled trials (RCTs). All RCTs were comparing intrathecal analgesia and local infiltration analgesia in TJA. Primary outcomes were the visual analog scale (VAS) score with rest or mobilization up to 72 h. Secondary outcomes were the total morphine consumption, length of hospital stay, and morphine-related complications. Compared with the intrathecal analgesia group, the LIA group was associated with a reduction in VAS score with rest up to 72 h. Moreover, LIA was associated with a decrease in VAS score with mobilization at 6 h, 12 h, 48 h, and 72 h. Moreover, LIA significantly reduced total morphine consumption (weighted mean difference (WMD) = − 15.37, 95% CI − 22.64 to − 8.83, P = 0.000), length of hospital stay (WMD = − 1.39, 95% CI − 1.67 to − 1.11, P = 0.000), and morphine-related complications (nausea and pruritus). Local infiltration provided superior analgesia and morphine-sparing effects within the first 72 h compared with ITM following TJA.

中文翻译：

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鞘内与局部浸润镇痛在全关节置换术中控制疼痛

这项荟萃分析的目的是评估鞘内吗啡（ITM）镇痛和局部浸润镇痛（LIA）在全关节置换术（TJA）中控制疼痛的功效。系统搜索了Embase，PubMed，Cochrane图书馆和Web of Science，以寻找随机对照试验（RCT）。所有RCT均在比较TJA的鞘内镇痛和局部浸润镇痛。主要结果是视觉模拟量表（VAS）评分，静息或动员长达72小时。次要结果是总吗啡消耗量，住院时间和吗啡相关并发症。与鞘内镇痛组相比，LIA组的VAS评分降低，休息长达72小时。此外，LIA与在6 h，12 h，48 h和72 h动员的VAS评分降低有关。此外，LIA显着降低了吗啡总消费量（加权平均差异（WMD）= − 15.37，95％CI − 22.64至− 8.83，P = 0.000），住院时间（WMD = − 1.39，95％CI − 1.67至− 1.11，P = 0.000）和吗啡相关并发症（恶心和瘙痒）。与TJA后的ITM相比，局部浸润在头72小时内提供了较好的镇痛和吗啡保护作用。