Hiroyuki Seki1,2, Toshiya Shiga3, Takahiro Mihara4,5, Hiroshi Hoshijima6, Yuki Hosokawa7, Shunsuke Hyuga8, Tomoe Fujita8, Kyotaro Koshika9, Reina Okada9, Hitomi Kurose10, Satoshi Ideno11, Takashi Ouchi9. 1. Department of Anesthesiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan. hshiroyukiseki@gmail.com. 2. Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2, ShinkawaTokyo, Mitaka, 181-8611, Japan. hshiroyukiseki@gmail.com. 3. Department of Anesthesiology, School of Medicine, International University of Health and Welfare, Chiba, Japan. 4. Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Kanagawa, Japan. 5. Department of Health Data Science, Yokohama City University Graduate School of Data Science, Kanagawa, Japan. 6. Division of Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Miyagi, Japan. 7. Department of Anesthesiology, Showa University School of Medicine, Tokyo, Japan. 8. Department of Anesthesiology, Kitasato University School of Medicine, Kanagawa, Japan. 9. Department of Anesthesiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan. 10. Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan. 11. Department of Anesthesiology, Kawasaki Municipal Hospital, Kanagawa, Japan.
Abstract
PURPOSE: We aimed to compare the beneficial and harmful effects of opioids used as adjuncts to local anesthetics in patients undergoing cesarean section under spinal anesthesia. METHODS: We searched electronic databases and ClinicalTrials.gov from their inception until March, 2021 without language restrictions. The primary outcome was the complete analgesia duration (Time to VAS > 0). Data were synthesized using the Bayesian random-effects model. Evidence confidence was evaluated using the Confidence In Network Meta-Analysis. RESULTS: We identified 66 placebo-controlled randomized controlled trials (RCTs) comprising 4400 patients undergoing elective cesarean section. Compared with the placebo, intrathecal opioids (fentanyl, sufentanil, and morphine) significantly prolonged the analgesia duration by 96, 96, and 190 min, respectively (mean difference). Despite morphine ranking first, opioid efficacy was similar; the results were inconsistent with respect to other analgesic outcomes. Except for diamorphine, all opioids were associated with significant increases in the pruritus incidence. Sufentanil and morphine were associated with increases in the respiratory depression incidence. CONCLUSIONS: We confirmed that intrathecal opioids benefit postoperative analgesia. Although morphine seems to be the most appropriate agent, some results were inconsistent, and the evidence confidence was often moderate or low, especially for adverse outcomes. Well-designed RCTs with an evidence-based approach are imperative for determining the most appropriate opioid for cesarean sections.
PURPOSE: We aimed to compare the beneficial and harmful effects of opioids used as adjuncts to local anesthetics in patients undergoing cesarean section under spinal anesthesia. METHODS: We searched electronic databases and ClinicalTrials.gov from their inception until March, 2021 without language restrictions. The primary outcome was the complete analgesia duration (Time to VAS > 0). Data were synthesized using the Bayesian random-effects model. Evidence confidence was evaluated using the Confidence In Network Meta-Analysis. RESULTS: We identified 66 placebo-controlled randomized controlled trials (RCTs) comprising 4400 patients undergoing elective cesarean section. Compared with the placebo, intrathecal opioids (fentanyl, sufentanil, and morphine) significantly prolonged the analgesia duration by 96, 96, and 190 min, respectively (mean difference). Despite morphine ranking first, opioid efficacy was similar; the results were inconsistent with respect to other analgesic outcomes. Except for diamorphine, all opioids were associated with significant increases in the pruritus incidence. Sufentanil and morphine were associated with increases in the respiratory depression incidence. CONCLUSIONS: We confirmed that intrathecal opioids benefit postoperative analgesia. Although morphine seems to be the most appropriate agent, some results were inconsistent, and the evidence confidence was often moderate or low, especially for adverse outcomes. Well-designed RCTs with an evidence-based approach are imperative for determining the most appropriate opioid for cesarean sections.
Authors: J Oji-Zurmeyer; C M Ortner; K U Klein; M Gries; C Kühn; T Schroffenegger; G Putz; S Jochberger Journal: Int J Obstet Anesth Date: 2019-02-15 Impact factor: 2.603
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Authors: Paul R Burchard; Alexa D Melucci; Olivia Lynch; Anthony Loria; Yatee A Dave; Myla Strawderman; Luke O Schoeniger; Eva Galka; Jacob Moalem; David C Linehan Journal: J Am Coll Surg Date: 2022-05-04 Impact factor: 6.532