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Effects of intrathecal opioids on cesarean section: a systematic review and Bayesian network meta-analysis of randomized controlled trials

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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.

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Authors and Affiliations

  1. Department of Anesthesiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan

    Hiroyuki Seki, Kyotaro Koshika, Reina Okada & Takashi Ouchi

  2. Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2, ShinkawaTokyo, Mitaka, 181-8611, Japan

    Hiroyuki Seki

  3. Department of Anesthesiology, School of Medicine, International University of Health and Welfare, Chiba, Japan

    Toshiya Shiga

  4. Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Kanagawa, Japan

    Takahiro Mihara

  5. Department of Health Data Science, Yokohama City University Graduate School of Data Science, Kanagawa, Japan

    Takahiro Mihara

  6. Division of Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Miyagi, Japan

    Hiroshi Hoshijima

  7. Department of Anesthesiology, Showa University School of Medicine, Tokyo, Japan

    Yuki Hosokawa

  8. Department of Anesthesiology, Kitasato University School of Medicine, Kanagawa, Japan

    Shunsuke Hyuga & Tomoe Fujita

  9. Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan

    Hitomi Kurose

  10. Department of Anesthesiology, Kawasaki Municipal Hospital, Kanagawa, Japan

    Satoshi Ideno

Authors
  1. Hiroyuki Seki
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  2. Toshiya Shiga
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  3. Takahiro Mihara
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  4. Hiroshi Hoshijima
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  5. Yuki Hosokawa
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  6. Shunsuke Hyuga
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  7. Tomoe Fujita
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  8. Kyotaro Koshika
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  9. Reina Okada
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  10. Hitomi Kurose
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  11. Satoshi Ideno
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  12. Takashi Ouchi
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Contributions

Seki serves as the contact person of this review. Conceiving the review: Seki. Designing the review: Seki, Kurose, Shiga. Coordinating the review: Seki, Shiga. Data collection for the review: Kurose, Ideno, Seki, Ouchi, Koshika, Okada, Hosokawa, Hyuga, Fujita. Data management for the review: Seki. Analysis of data: Shiga, Mihara, Hoshijima. Interpretation of data: Kurose, Ideno, Seki, Ouchi, Koshika, Okada, Hosokawa, Hyuga, Fujita, Shiga, Mihara, Hoshijima. Writing the review: Seki, Shiga, Kurose. Providing general advice on the review: Shiga, Mihara, Hoshijima. Writing the protocol: Kurose, Seki, Shiga.

Corresponding author

Correspondence to Hiroyuki Seki.

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Seki, H., Shiga, T., Mihara, T. et al. Effects of intrathecal opioids on cesarean section: a systematic review and Bayesian network meta-analysis of randomized controlled trials. J Anesth 35, 911–927 (2021). https://doi.org/10.1007/s00540-021-02980-2

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  • DOI: https://doi.org/10.1007/s00540-021-02980-2

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