Pain Pract. 2021 Apr 22. doi: 10.1111/papr.13021. Online ahead of print.
ABSTRACT
PURPOSE: Various adjuvants for prolongation of intraoperative and postoperative analgesia have been clinically studied, but the safety and efficiency of nalbuphine as an adjuvant to local anesthetics in spinal anesthesia remains unconfirmed. Therefore, we conducted a meta-analysis about the effect of nalbuphine as an adjuvant to local anesthetics in spinal anesthesia in regard to time of onset of sensory blockade and motor blockade,duration of motor blockade, two-segment sensory regression time, the duration of analgesia, and incidence of side effects to provide a reliable basis for clinical application.
METHODS: Databases including PubMed, Cochrane, EMBASE, Web of Science, CNKI, CBM, WanFang database and Viper database were searched for eligible studies. Data was extracted according to the proposed inclusion and exclusion criteria, RevMan 5.3 and Stata16 were selected to perform meta-analysis.
RESULTS: Eighteen published studies including 1633 patients met the inclusion criteria. The results showed that adding nalbuphine to local anesthetics for spinal anesthesia can prolong two-segment sensory regression time [MD=24.31; 95% CI 19.61~29.00, P < 0.001] and the duration of analgesia [(MD =118.11;95%CI 71.34 ~ 164.89, P < 0.001]without significantly increasing the incidence of adverse reactions in comparison to normal saline group. What’s more, the analgesic effect of nalbuphine group was not statistically different from that of control group when compared with the potent opioid group, but the occurrence of hypotension(RR = 0.35, 95% CI: 0.18-0.68, P<0.01), the occurrence of shivering(RR = 0.19, 95% CI: 0.08-0.43, P<0.01)and the occurrence of pruritus (RR = 0.23, 95% CI: 0.10-0.53, P<0.01) was lower than the potent opioid group.
CONCLUSIONS: Nalbuphine as additives to local anesthetics can significantly prolong the two segments of sensory block and the average duration of analgesia without increasing the incidence of adverse reactions when compared with normal saline group. And the analgesic efficacy of nalbuphine served as an adjunct to local anaesthetics was clinically not different from that of the potent opioids, but the occurrence of hypotension, shivering and pruritus was lower than the potent opioids.
PMID:33887111 | DOI:10.1111/papr.13021
