Safety and effectiveness of adding fentanyl or sufentanil to spinal anesthesia: systematic review and meta-analysis of randomized controlled trials
Segurança e eficácia da adição de fentanil ou sufentanil à raquianestesia: revisão sistemática e meta-análise de ensaios clínicos randomizados
Neuber Martins Fonseca, Gabriel Magalhães Nunes Guimarães, João Paulo Jordão Pontes, Liana Maria Torres de Araujo Azi, Ricardo de Ávila Oliveira
Abstract
Introduction: Spinal infusions of either fentanyl or sufentanil have been reported in international reports, articles, and scientific events worldwide. This study aimed to determine whether intrathecal fentanyl or sufentanil offers safety in mortality and perioperative adverse events.
Methods: MEDLINE (via PubMed), EMBASE, CENTRAL (Cochrane library databases), gray literature, hand-searching, and clinicaltrials.gov were systematically searched. Randomized controlled trials with no language, data, or status restrictions were included, comparing the effectiveness and safety of adding spinal lipophilic opioid to local anesthetics (LAs). Data were pooled using the random-effects models or fixed-effect models based on heterogeneity.
Results: The initial search retrieved 4469 records; 3241 records were eligible, and 3152 articles were excluded after reading titles and abstracts, with a high agreement rate (98.6%). After reading the full texts, 76 articles remained. Spinal fentanyl and sufentanil significantly reduced postoperative pain and opioid consumption, increased analgesia and pruritus. Fentanyl, but not sufentanil, significantly reduced both postoperative nausea and vomiting, and postoperative shivering; compared to LAs alone. The analyzed studies did not report any case of in-hospital mortality related to spinal lipophilic opioids. The rate of respiratory depression was 0.7% and 0.8% when spinal fentanyl or sufentanil was added and when it was not, respectively. Episodes of respiratory depression were rare, uneventful, occurred intraoperatively, and were easily manageable.
Conclusion: There is moderate to high quality certainty that there is evidence regarding the safety and effectiveness of adding lipophilic opioids to LAs in spinal anesthesia.
Keywords
Resumo
Introdução
Infusões espinhais de fentanil ou sufentanil foram relatadas em relatórios, artigos e eventos científicos internacionais em todo o mundo. Este estudo teve como objetivo determinar se fentanil intratecal ou sufentanil oferece segurança na mortalidade e eventos adversos perioperatórios.
Métodos
MEDLINE (via PubMed), EMBASE, CENTRAL (bancos de dados da biblioteca Cochrane), literatura cinza, pesquisa manual e Clinicaltrials.gov foram sistematicamente pesquisados. Ensaios clínicos randomizados sem restrições de idioma, dados ou status foram incluídos, comparando a eficácia e a segurança da adição de opioides lipofílicos espinhais aos anestésicos locais (ALs). Os dados foram agrupados usando os modelos de efeitos aleatórios ou modelos de efeito fixo com base na heterogeneidade.
Resultados
A busca inicial recuperou 4.469 registros; Foram elegíveis 3.241 registros e 3.152 artigos foram excluídos após leitura de títulos e resumos, com alto índice de concordância (98,6%). Após a leitura dos textos completos, restaram 76 artigos. O fentanil e o sufentanil espinhais reduziram significativamente a dor pós-operatória e o consumo de opioides, aumentaram a analgesia e o prurido. O fentanil, mas não o sufentanil, reduziu significativamente as náuseas e vômitos pós-operatórios e os tremores pós-operatórios; em comparação com os LAs sozinhos. Os estudos analisados não relataram nenhum caso de mortalidade intra-hospitalar relacionada aos opioides lipofílicos espinhais. A taxa de depressão respiratória foi de 0,7% e 0,8% quando fentanil ou sufentanil espinhal foi adicionado e quando não foi adicionado, respectivamente. Episódios de depressão respiratória foram raros, sem intercorrências, ocorreram no intraoperatório e foram facilmente controlados.
Conclusão
Há uma certeza de qualidade moderada a alta de que há evidências sobre a segurança e a eficácia da adição de opioides lipofílicos aos ALs na raquianestesia.
Palavras-chave
References
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Submitted date:
06/24/2021
Accepted date:
10/02/2021
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