【罂粟摘要】在脊髓麻醉中加入芬太尼或舒芬太尼的安全性和有效性：一项随机对照试验的系统回顾和meta分析

在脊髓麻醉中加入芬太尼或舒芬太尼的安全性和有效性：一项随机对照试验的系统回顾和meta分析

贵州医科大学麻醉与心脏电生理课题组

翻译：邓举  

编辑：宋雨婷  

审校：曹莹

背景

鞘内注射芬太尼或舒芬太尼已经在世界各地的国际报告、文章和科学事件中被报道。本研究旨在确定鞘内注射芬太尼或舒芬太尼在死亡率和围手术期不良事件中是否具有安全性。

方法

系统地检索Medline（通过PubMed）、EMBASE、CENTRAL（科克伦图书馆数据库）、灰色文献、手工检索和clinicaltrials.gov。本试验纳入了没有语言、数据或状态限制的随机对照试验，比较了在局部麻醉药（LAs）中添加脊髓亲脂性阿片类药物的有效性和安全性。数据采用随机效应模型或基于异质性的固定效应模型进行汇总。

结果

首次检索到4469条记录；有3241条记录符合条件，阅读标题和摘要后有3152篇文章被排除，符合率较高（98.6%）。在阅读完全文后，还剩下76篇文章。鞘内芬太尼和舒芬太尼显著减少术后疼痛和阿片类药物消耗，增加镇痛和瘙痒。与单纯LAs相比，加入芬太尼，而非舒芬太尼，显著减少术后恶心和呕吐，以及术后寒颤。所分析的研究没有报道任何与脊髓亲脂性阿片类药物相关的住院死亡病例。加入鞘内芬太尼或舒芬太尼和都不加相比，呼吸抑制率分别为0.7%和0.8%。呼吸抑制的发生非常罕见，发生在术中，情况平稳，且易于管理。

结论

有中等到高等质量的证据表明在脊髓麻醉中添加亲脂性阿片类药物的安全性和有效性是确切的。

原始文献来源

Neuber Martins Fonseca,Gabriel Magalhaes Nunes Guimaraes, Joao Paulo Jordao Pontes,et al.Safety and effectiveness of adding fentanyl or sufentanil to spinal anesthesia: systematic review and meta-analysis of randomized controlled trials [J].Brazilian Journal of Anesthesiology 2023;73(2): 198−216 .

英文原文

Safety and effectiveness of adding fentanyl or sufentanil to spinal anesthesia: systematic review and meta-analysis of randomized controlle d trials

Introduction: Spinal infusions of either fentanyl or sufentanil have been reported in international reports, articles, and scientifific 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 fifixed-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 signifificantly reduced postoperative pain and opioid consumption, increased analgesia and pruritus. Fentanyl, but not sufentanil, signifificantly 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.

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