Background: This meta-analysis aims to illustrate the efficacy and safety of intrathecal morphine (ITM) versus\nfemoral nerve block (FNB) for pain control after total knee arthroplasty (TKA).\nMethods: In April 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science,\nCochrane Database of Systematic Reviews, Cami Info. Inc., Casalini databases, EBSCO databases, Verlag database and\nGoogle database. Data on patients prepared for TKA surgery in studies that compared ITM versus FNB for pain control\nafter TKA were collected. The main outcomes were the visual analogue scale (VAS) at 6, 12, 24, 48 and 72 and total\nmorphine consumption at 12, 24 and 48 h. The secondary outcomes were complications that included postoperative\nnausea and vomiting (PONV) and itching. Stata 12.0 was used for pooling the data.\nResults: Five clinical studies with a total of 225 patients (ITM group = 114, FNB group = 111) were ultimately included in\nthe meta-analysis. The results revealed that the ITM group was associated with a reduction of VAS at 6, 12, 24, 48 and\n72 h and total morphine consumption at 12, 24 and 48 h. There was no significant difference between the occurrences\nof PONV. However, the ITM group was associated with an increased occurrence of itching after TKA.\nConclusions: Some immediate analgesic efficacy and opioid-sparing effects were obtained with the administration of\nITM when compared with FNB. The complications of itching in the ITM group were greater than in the FNB group. The\nsample size and the quality of the included studies were limited. A multi-centre RCT is needed to identify the optimal\nmethod for reaching maximum pain control after TKA.
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