TY - JOUR
T1 - The effect of two groups of intrathecal fentanyl doses on analgesic outcomes and adverse effects in parturients undergoing cesarean delivery
T2 - a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis
AU - Singh, N. P.
AU - Makkar, J. K.
AU - Jafra, A.
AU - Verma, P.
AU - Singh, P. Mohinder
N1 - Publisher Copyright:
© 2022 Elsevier Ltd
PY - 2022/5
Y1 - 2022/5
N2 - Background: Variable doses of intrathecal fentanyl (ITF) have been used for peri-operative analgesia during cesarean delivery (CD). We conducted a systematic review and meta-analysis to compare lower doses (LD; ≤12.5 µg) and higher doses (HD; >12.5 µg) of ITF in parturients undergoing CD. Methods: Databases were searched from inception to December 2020 for randomized controlled trials (RCTs) administering ITF as an additive to local anesthetic. The primary outcome was the use of intra-operative analgesic supplementation. Time to first rescue analgesia, the incidence of peri-operative side effects and neonatal outcomes were secondary outcomes. Additional analysis was performed after stratifying trials using ≤15 µg and >15 µg of ITF. Mean difference (MD) and risk difference (RD) with 95% confidence interval (CI) were calculated. Results: Eleven RCTs met inclusion criteria. Study groups were 601 patients (LD) and 749 patients (HD). A HD of ITF reduced the risk for supplementation by 6% (95% CI 0 to 13%; P=0.05; I2=80%) compared with LD, and increased the time first rescue analgesia (MD 55.2 min, 95% CI 20.3 to 90.1, P=0.002; I2=100%). The risk of pruritus increased by 13% (95% CI 5 to 21%; P=0.001; I2=81%). Pooled data suggest that the incidence of nausea and vomiting, and neonatal outcomes did not significantly differ. Conclusions: In women undergoing CD, doses of ITF >12.5 µg reduced the requirement for intra-operative analgesic supplementation and prolonged the time to first rescue analgesia compared with smaller doses, but increased pruritus. On revising the cut-off to 15 µg, no significant difference was found.
AB - Background: Variable doses of intrathecal fentanyl (ITF) have been used for peri-operative analgesia during cesarean delivery (CD). We conducted a systematic review and meta-analysis to compare lower doses (LD; ≤12.5 µg) and higher doses (HD; >12.5 µg) of ITF in parturients undergoing CD. Methods: Databases were searched from inception to December 2020 for randomized controlled trials (RCTs) administering ITF as an additive to local anesthetic. The primary outcome was the use of intra-operative analgesic supplementation. Time to first rescue analgesia, the incidence of peri-operative side effects and neonatal outcomes were secondary outcomes. Additional analysis was performed after stratifying trials using ≤15 µg and >15 µg of ITF. Mean difference (MD) and risk difference (RD) with 95% confidence interval (CI) were calculated. Results: Eleven RCTs met inclusion criteria. Study groups were 601 patients (LD) and 749 patients (HD). A HD of ITF reduced the risk for supplementation by 6% (95% CI 0 to 13%; P=0.05; I2=80%) compared with LD, and increased the time first rescue analgesia (MD 55.2 min, 95% CI 20.3 to 90.1, P=0.002; I2=100%). The risk of pruritus increased by 13% (95% CI 5 to 21%; P=0.001; I2=81%). Pooled data suggest that the incidence of nausea and vomiting, and neonatal outcomes did not significantly differ. Conclusions: In women undergoing CD, doses of ITF >12.5 µg reduced the requirement for intra-operative analgesic supplementation and prolonged the time to first rescue analgesia compared with smaller doses, but increased pruritus. On revising the cut-off to 15 µg, no significant difference was found.
KW - Analgesia
KW - Cesarean delivery
KW - Intrathecal fentanyl
KW - Meta-analysis
KW - Pruritus
UR - http://www.scopus.com/inward/record.url?scp=85126004278&partnerID=8YFLogxK
U2 - 10.1016/j.ijoa.2022.103270
DO - 10.1016/j.ijoa.2022.103270
M3 - Article
C2 - 35279459
AN - SCOPUS:85126004278
SN - 0959-289X
VL - 50
JO - International Journal of Obstetric Anesthesia
JF - International Journal of Obstetric Anesthesia
M1 - 103270
ER -