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Meta-analysis
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English

Combination of a reduced dose of an intrathecal local anesthetic with a small dose of an opioid: a meta-analysis of randomized trials

Contributors

Pöpping, Daniel M; Elia, Nadia; Wenk, Manuel; Tramer, Martin

Published in

Pain, vol. 154, no. 8, p. 1383-1390

Publication date

2013

Abstract

We tested whether the combination of a reduced dose of a local anesthetic (LA) with an opioid compared with a standard dose of the same LA alone guaranteed adequate intraoperative anesthesia and postoperative analgesia and decreased LA-related adverse effects. We systematically searched (to November 2012) for randomized comparisons of combinations of a reduced dose of an LA with a concomitant opioid (experimental) with a standard dose of the LA alone (control) in adults undergoing surgery with single-injection intrathecal anesthesia without general anesthesia. We included 28 trials (1393 patients). In experimental groups, the median decrease in LA doses was 40% (range, 12%-70%). There was no difference between experimental and control groups in the need for intraoperative opioids or general anesthesia for failed block or in the duration of postoperative analgesia. With experimental interventions, there was evidence of a reduction in the duration of motor blockade postoperatively (average, -50 minutes), time to discharge from hospital or PACU (-33 minutes), time to ambulation (-28 minutes), and time to urination (-14 minutes). There was also evidence of a decrease in the risk of shivering (risk ratio [RR]: 0.26; 95% confidence interval [CI]: 0.12-0.56), nausea (RR: 0.45; 95% CI: 0.31-0.66), and arterial hypotension (RR: 0.52; 95% CI: 0.35-0.78). The risk of pruritus was increased (RR: 11.7; 95% CI: 6.2-21.9). Adding an opioid to a reduced dose of an intrathecal LA can decrease LA-related adverse effects and improve recovery from the spinal block without compromising intraoperative anesthesia or duration of postoperative analgesia.

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UNIGE research groups

Citation (ISO format)

PÖPPING, Daniel M et al. Combination of a reduced dose of an intrathecal local anesthetic with a small dose of an opioid: a meta-analysis of randomized trials. In: Pain, 2013, vol. 154, n° 8, p. 1383–1390. doi: 10.1016/j.pain.2013.04.023

Main files (1)

Article (Published version)

Identifiers

Journal ISSN

0304-3959
718views
2031downloads

Technical informations

Creation

28/10/2013 16:29:00

First validation

28/10/2013 16:29:00

Update

14/03/2023 20:48:16

Status update

14/03/2023 20:48:15

Last indexation

29/09/2025 14:17:33
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