title: Comparison of intrathecal and local infiltration analgesia by morphine for pain management in total knee and hip arthroplasty: A meta-analysis of randomized controlled trial.
abstract: OBJECTIVE
  We performed a meta-analysis from randomized controlled trials to evaluate the efficiency and safety between local infiltration analgesia and intrathecal morphine for pain control in total knee and hip arthroplasty.
  
  
  METHODS
  We systemically searched electronic databases including Embase (1980-2016.7), Medline (1966-2016.7), PubMed (1966-2016.7), ScienceDirect (1985-2016.7), web of science (1950-2016.7) and Cochrane Library for relevant articles. All calculation was carried out by Stata 11.0.
  
  
  RESULTS
  Four randomized controlled trials (RCTs) involving 242 patients met the inclusion criteria. The meta-analysis showed that there were significant differences in terms of postoperative pain scores at 24 h during rest (P = 0.008) and mobilization (P = 0.049) following total knee and hip arthroplasty. Significant difference was found regarding the incidence of nausea (P = 0.030), vomiting (P = 0.005), and pruritus (P = 0.000) between two groups. There was no significant difference between groups in terms of morphine equivalent consumption at postoperative 24 or 48 h.
  
  
  CONCLUSIONS
  Local infiltration analgesia (LIA) provided superior analgesic effects within the first 24 h compared to intrathecal morphine (ITM) following total knee and hip arthroplasty. There were fewer adverse effects in LIA. Doses of morphine consumption were similar in the two groups.
authors.affiliation: Orthopedics Department, Jianyang People's Hospital, Sichuan, 641400, PR China.
authors.forename: Xu-Feng
authors.initials: XF
authors.lastname: Jia
authors.affiliation: Orthopedics Department, Jianyang People's Hospital, Sichuan, 641400, PR China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Ji
authors.affiliation: Orthopedics Department, Jianyang People's Hospital, Sichuan, 641400, PR China. Electronic address: 1941842317@qq.com.
authors.forename: Guang-Ping
authors.initials: GP
authors.lastname: Huang
authors.affiliation: Orthopedics Department, Jianyang People's Hospital, Sichuan, 641400, PR China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Orthopedics Department, Jianyang People's Hospital, Sichuan, 641400, PR China.
authors.forename: Miao
authors.initials: M
authors.lastname: Long
mesh_terms: D000368:Aged; D000698:Analgesia / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000779:Anesthetics, Local; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine
keywords: Intrathecal morphine; Local infiltration analgesia; Meta-analysis; Total knee and hip arthroplasty