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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 maternal shivering incidence.Forest plot displaying the results of the fixed effects meta-analysis for maternal shivering 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.g012: Forest plot of maternal shivering incidence.Forest plot displaying the results of the fixed effects meta-analysis for maternal shivering incidence in sufentanil and bupivacaine combination versus bupivacaine alone. Sufentanil, sufentanil and bupivacaine combination. Control, bupivacaine alone. RR, relative risk. CI, confidence interval.

Mentions: Maternal side effects including hypotension [9–12, 14, 16], nausea [10–14, 16, 17], vomiting [10, 12–17], pruritus [10–18], and shivering[10, 12, 14] were compared between sufentanil added and bupivacaine alone groups. There were no significant differences in the incidence of hypotension, and vomiting. However, the CIs were wide and heterogeneity was significant. Sufentanil addition significantly increased the incidence of pruritus (Figs 8–12). Sufentanil additiondid not affect the incidence of nausea; however, when the trial of Bang et al [14] was removed from the analysis, the incidence of nausea was significantly lower in the sufentanil combined with bupivacaine group (RR = 0.58, 95% CI 0.40 to 0.85). The pooled results showed that the incidence of shivering was lower in thesufentanil added group, but this conclusion did not stand true when the trial of Lee et al [10] was removed from the analysis (RR = 0.52, 95% CI 0.28 to 0.94). Further evidences maybe required to reach a clear conclusion about the effects on the incidence of nausea and shivering of sufentanil added or bupivacaine alone.


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 maternal shivering incidence.Forest plot displaying the results of the fixed effects meta-analysis for maternal shivering 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.g012: Forest plot of maternal shivering incidence.Forest plot displaying the results of the fixed effects meta-analysis for maternal shivering incidence in sufentanil and bupivacaine combination versus bupivacaine alone. Sufentanil, sufentanil and bupivacaine combination. Control, bupivacaine alone. RR, relative risk. CI, confidence interval.
Mentions: Maternal side effects including hypotension [9–12, 14, 16], nausea [10–14, 16, 17], vomiting [10, 12–17], pruritus [10–18], and shivering[10, 12, 14] were compared between sufentanil added and bupivacaine alone groups. There were no significant differences in the incidence of hypotension, and vomiting. However, the CIs were wide and heterogeneity was significant. Sufentanil addition significantly increased the incidence of pruritus (Figs 8–12). Sufentanil additiondid not affect the incidence of nausea; however, when the trial of Bang et al [14] was removed from the analysis, the incidence of nausea was significantly lower in the sufentanil combined with bupivacaine group (RR = 0.58, 95% CI 0.40 to 0.85). The pooled results showed that the incidence of shivering was lower in thesufentanil added group, but this conclusion did not stand true when the trial of Lee et al [10] was removed from the analysis (RR = 0.52, 95% CI 0.28 to 0.94). Further evidences maybe required to reach a clear conclusion about the effects on the incidence of nausea and shivering of sufentanil added or bupivacaine alone.

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