{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T15:47:09Z","timestamp":1787932029244,"version":"build-2784847793"},"reference-count":33,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,6,23]],"date-time":"2024-06-23T00:00:00Z","timestamp":1719100800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2024,6,23]],"date-time":"2024-06-23T00:00:00Z","timestamp":1719100800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intrathecal diamorphine is believed to provide postoperative analgesia but is associated with adverse effects such as nausea and vomiting. There is little evidence of synthesis regarding intrathecal diamorphine in the contemporary literature. We performed a systematic review, meta\u2010analysis with meta\u2010regression and trial sequential analysis to determine the magnitude of intrathecal diamorphine efficacy and safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We systematically searched the literature for trials comparing intrathecal diamorphine with a control group in patients undergoing all types of surgery. The primary efficacy and safety outcomes were intravenous morphine consumption and incidence of postoperative nausea and vomiting at 24\u2009h following surgery, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twelve trials were identified, which included data for 712 patients. Intrathecal doses of diamorphine ranged from 100\u2009\u03bcg to 2500\u2009\u03bcg. Intravenous morphine consumption at 24\u2009h postoperatively was significantly reduced in the intrathecal diamorphine group, with a mean difference (95%CI) of \u20108\u2009mg (\u201011 to \u20106), I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200993%, p\u2009&lt;\u20090.001. There was a significant difference between three intrathecal diamorphine dosing subgroups but without correlation: mean differences (95%CI) \u20101\u2009mg (\u20103\u20130), \u201026\u2009mg (\u201040 to \u201011) and \u20106\u2009mg (\u201015\u20134) in patients receiving doses of 0\u2013200\u2009\u03bcg, 201\u2013400\u2009\u03bcg and\u2009&gt;\u2009400\u2009\u03bcg, respectively (p\u2009=\u20090.003). Intrathecal diamorphine increased postoperative nausea and vomiting with a risk ratio (95%CI) of 1.37 (1.19\u20131.58), I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20097%, p\u2009&lt;\u20090.001. There were no differences in postoperative nausea and vomiting between the three intrathecal diamorphine dosing subgroups. There was no correlation observed with meta\u2010regression of the primary efficacy and safety outcomes. The quality of evidence for all outcomes was very low.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>There is very low level of evidence that intrathecal diamorphine provides effective analgesia after surgery, while increasing postoperative nausea and vomiting with doses &gt;\u2009200\u2009\u03bcg.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/anae.16359","type":"journal-article","created":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T01:29:17Z","timestamp":1719192557000},"page":"1081-1090","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Efficacy and safety of intrathecal diamorphine: a systematic review and meta\u2010analysis with meta\u2010regression and trial sequential analysis"],"prefix":"10.1111","volume":"79","author":[{"given":"Sina","family":"Grape","sequence":"first","affiliation":[{"name":"Department of Anaesthesia Valais Hospital  Sion Switzerland"},{"name":"University of Lausanne  Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kariem","family":"El\u2010Boghdadly","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia Guy's and St Thomas' NHS Foundation Trust  London UK"},{"name":"King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecile","family":"Jaques","sequence":"additional","affiliation":[{"name":"Medical Library Lausanne University Hospital and University of Lausanne  Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6432-1311","authenticated-orcid":false,"given":"Eric","family":"Albrecht","sequence":"additional","affiliation":[{"name":"University of Lausanne  Lausanne Switzerland"},{"name":"Department of Anaesthesia University Hospital of Lausanne and University of Lausanne  Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,23]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2020.05.061"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102021\u2010057407"},{"key":"e_1_2_6_4_1","unstructured":"National Institute for Health and Care Excellence.2021 exceptional surveillance of caesarean birth \u2013 diamorphine. 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