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Sufentanil and Bupivacaine Combination versus Bupivacaine Alone for Spinal Anesthesia during Cesarean Delivery: A Meta-Analysis of Randomized Trials.

Hu J, Zhang C, Yan J, Wang R, Wang Y, Xu M - PLoS ONE (2016)

Bottom Line: Sensory block onset time was shorter and first analgesic request time was longer in sufentanil added group compared with the bupivacaine-alone group (WMD = -1.0 min, 95% CI -1.5 to -0.58, P < 0.001 and WMD = 133 min, 95% CI 75 to 213, P < 192, respectively).There was no significant difference in the risk of hypotension and vomiting between these two groups.However, the addition of sufentanil to bupivacaine increased the incidence of pruritus.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China.

ABSTRACT

Objective: The addition of lipophilic opioids to local anesthetics for spinal anesthesia has become a widely used strategy for cesarean anesthesia. A meta-analysis to quantify the benefits and risks of combining sufentanil with bupivacaine for patients undergoing cesarean delivery was conducted.

Methods: A comprehensive literature search without language or date limitation was performed to identify clinical trials that compared the addition of sufentanil to bupivacaine with bupivacaine alone for spinal anesthesia in healthy parturients choosing cesarean delivery. The Q and I2 tests were used to assess heterogeneity of the data. Data from each trial were combined using relative ratios (RRs) for dichotomous data or weighted mean differences (WMDs) for continuous data and corresponding 95% confidence intervals (95% CIs) for each trial. Sensitivity analysis was conducted by removing one study a time to assess the quality and consistency of the results. Begg's funnel plots and Egger's linear regression test were used to detect any publication bias.

Results: This study included 9 trials containing 578 patients in the final meta-analysis. Sufentanil addition provided a better analgesia quality with less breakthrough pain during surgery than bupivacaine alone (RR = 0.10, 95% CI 0.06 to 0.18, P < 0.001). Sensory block onset time was shorter and first analgesic request time was longer in sufentanil added group compared with the bupivacaine-alone group (WMD = -1.0 min, 95% CI -1.5 to -0.58, P < 0.001 and WMD = 133 min, 95% CI 75 to 213, P < 192, respectively). There was no significant difference in the risk of hypotension and vomiting between these two groups. But pruritus was more frequentely reported in the group with sufentanil added (RR = 7.63, 95% CI 3.85 to 15.12, P < 0.001).

Conclusion: Bupivacaine and sufentanil combination is superior to that of bupivacaine alone for spinal anesthesia for cesarean delivery in analgesia quality. Women receiving the combined two drugs had less breakthrough pain, shorter sensory block onset time, and longer first analgesic request time. However, the addition of sufentanil to bupivacaine increased the incidence of pruritus.

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Related in: MedlinePlus

Forest plot of breakthrough pain incidence.Forest plot displaying the results of the fixed effects meta-analysis for breakthrough pain incidence in sufentanil and bupivacaine combination versus bupivacaine alone. Sufentanil, sufentanil and bupivacaine combination. Control, bupivacaine alone. RR, relative risk. CI, confidence interval.
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pone.0152605.g002: Forest plot of breakthrough pain incidence.Forest plot displaying the results of the fixed effects meta-analysis for breakthrough pain incidence in sufentanil and bupivacaine combination versus bupivacaine alone. Sufentanil, sufentanil and bupivacaine combination. Control, bupivacaine alone. RR, relative risk. CI, confidence interval.

Mentions: Six trials [9–12, 14, 16] were pooled using a fixed effect model since no heterogeneity was observed (I2 < 0.1%, P = 0.73) when their anesthesia quality were examined. Bupivacaine and sufentanil combination significantly reduced the incidence of breakthrough pain during surgery compared with bupivacaine alone(RR = 0.10, 95% CI 0.06 to 0.18 P < 0.001, Fig 2). Breakthrough pain occurred in 10 of 138 patients in sufentanil group, and in 75 of 103 in bupivacaine-alone group. The result was stable when sensitivity analysis was conducted by removing 1 trial at a time from the pooled result (RRmin = 0.09, 95% CImin 0.04 to 0.18; RRmax = 0.12, 95% CImax 0.07 to 0.21, Fig 3). The Begg’s funnel plots (P = 1.00) and Egger’s linear regression test (P = 0.76) indicated the probability of publication bias was low (Fig 4).


Sufentanil and Bupivacaine Combination versus Bupivacaine Alone for Spinal Anesthesia during Cesarean Delivery: A Meta-Analysis of Randomized Trials.

Hu J, Zhang C, Yan J, Wang R, Wang Y, Xu M - PLoS ONE (2016)

Forest plot of breakthrough pain incidence.Forest plot displaying the results of the fixed effects meta-analysis for breakthrough pain incidence in sufentanil and bupivacaine combination versus bupivacaine alone. Sufentanil, sufentanil and bupivacaine combination. Control, bupivacaine alone. RR, relative risk. CI, confidence interval.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4816294&req=5

pone.0152605.g002: Forest plot of breakthrough pain incidence.Forest plot displaying the results of the fixed effects meta-analysis for breakthrough pain incidence in sufentanil and bupivacaine combination versus bupivacaine alone. Sufentanil, sufentanil and bupivacaine combination. Control, bupivacaine alone. RR, relative risk. CI, confidence interval.
Mentions: Six trials [9–12, 14, 16] were pooled using a fixed effect model since no heterogeneity was observed (I2 < 0.1%, P = 0.73) when their anesthesia quality were examined. Bupivacaine and sufentanil combination significantly reduced the incidence of breakthrough pain during surgery compared with bupivacaine alone(RR = 0.10, 95% CI 0.06 to 0.18 P < 0.001, Fig 2). Breakthrough pain occurred in 10 of 138 patients in sufentanil group, and in 75 of 103 in bupivacaine-alone group. The result was stable when sensitivity analysis was conducted by removing 1 trial at a time from the pooled result (RRmin = 0.09, 95% CImin 0.04 to 0.18; RRmax = 0.12, 95% CImax 0.07 to 0.21, Fig 3). The Begg’s funnel plots (P = 1.00) and Egger’s linear regression test (P = 0.76) indicated the probability of publication bias was low (Fig 4).

Bottom Line: Sensory block onset time was shorter and first analgesic request time was longer in sufentanil added group compared with the bupivacaine-alone group (WMD = -1.0 min, 95% CI -1.5 to -0.58, P < 0.001 and WMD = 133 min, 95% CI 75 to 213, P < 192, respectively).There was no significant difference in the risk of hypotension and vomiting between these two groups.However, the addition of sufentanil to bupivacaine increased the incidence of pruritus.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China.

ABSTRACT

Objective: The addition of lipophilic opioids to local anesthetics for spinal anesthesia has become a widely used strategy for cesarean anesthesia. A meta-analysis to quantify the benefits and risks of combining sufentanil with bupivacaine for patients undergoing cesarean delivery was conducted.

Methods: A comprehensive literature search without language or date limitation was performed to identify clinical trials that compared the addition of sufentanil to bupivacaine with bupivacaine alone for spinal anesthesia in healthy parturients choosing cesarean delivery. The Q and I2 tests were used to assess heterogeneity of the data. Data from each trial were combined using relative ratios (RRs) for dichotomous data or weighted mean differences (WMDs) for continuous data and corresponding 95% confidence intervals (95% CIs) for each trial. Sensitivity analysis was conducted by removing one study a time to assess the quality and consistency of the results. Begg's funnel plots and Egger's linear regression test were used to detect any publication bias.

Results: This study included 9 trials containing 578 patients in the final meta-analysis. Sufentanil addition provided a better analgesia quality with less breakthrough pain during surgery than bupivacaine alone (RR = 0.10, 95% CI 0.06 to 0.18, P < 0.001). Sensory block onset time was shorter and first analgesic request time was longer in sufentanil added group compared with the bupivacaine-alone group (WMD = -1.0 min, 95% CI -1.5 to -0.58, P < 0.001 and WMD = 133 min, 95% CI 75 to 213, P < 192, respectively). There was no significant difference in the risk of hypotension and vomiting between these two groups. But pruritus was more frequentely reported in the group with sufentanil added (RR = 7.63, 95% CI 3.85 to 15.12, P < 0.001).

Conclusion: Bupivacaine and sufentanil combination is superior to that of bupivacaine alone for spinal anesthesia for cesarean delivery in analgesia quality. Women receiving the combined two drugs had less breakthrough pain, shorter sensory block onset time, and longer first analgesic request time. However, the addition of sufentanil to bupivacaine increased the incidence of pruritus.

Show MeSH
Related in: MedlinePlus