Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing major surgery: meta-analysis of randomized trials N. Meylan,

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Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing major surgery: meta-analysis of randomized trials N. Meylan, N. Elia, C. Lysakowski, M.R. Tramèr British Journal of Anaesthesia Volume 102, Issue 2, Pages 156-167 (February 2009) DOI: 10.1093/bja/aen368 Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

Fig 1 Flow chart of retrieved, excluded, and analysed trials. RCT, randomized, controlled trial. Relevant trials tested intrathecal morphine alone (without a local anaesthetic) in patients undergoing a general anaesthetic for major surgery. British Journal of Anaesthesia 2009 102, 156-167DOI: (10.1093/bja/aen368) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

Fig 2 Relationship between the year of publication of the trials and the doses of intrathecal morphine that were investigated in the trials. Data are from 27 placebo-controlled randomized trials. Each symbol represents one trial arm that tested intrathecal morphine; number of symbols does not add up since some trials tested more than one morphine dose. British Journal of Anaesthesia 2009 102, 156-167DOI: (10.1093/bja/aen368) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

Fig 3 Cumulative 24 h consumption of i.v. morphine (in milligrams) for break-through pain after operation. IT, intrathecal; WMD, weighted mean difference; CI, confidence interval. On the bubble graph, each bubble represents one trial; sizes of the bubbles are proportional to sizes of the trials. British Journal of Anaesthesia 2009 102, 156-167DOI: (10.1093/bja/aen368) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

Fig 4 Pain intensity (0–10-point scale, ranging from 0, no pain, to 10, maximum pain) at rest at 2, 4, 12, and 24 h after operation. IT, intrathecal; WMD, weighted mean difference; CI, confidence interval. On the bubble graphs, axes are pain intensities (0–10-point scale). Each bubble represents one trial; sizes of the bubbles are proportional to sizes of the trials. British Journal of Anaesthesia 2009 102, 156-167DOI: (10.1093/bja/aen368) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions