Local anesthetic versus fentanyl or sufentanil spinal anesthesia: Systematic Review and meta-analysis
Description
Even though opioids are the most potent analgesics, it may increase postoperative complications, such as respiratory depression, hypoxemia, hyperalgesia, nausea and vomiting, pruritus, urinary retention, and tolerance desensitization, dizziness, and drowsiness. To our knowledge, no systematic review article has been done to investigate local anesthetic versus opioid spinal anesthesia to evaluate the incidence of postoperative complications.
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Steps to reproduce
Our goal is to compare spinal anesthesia with a local anesthetic used alone or combined with fentanyl or sufentanil or a combination of the first and possible postoperative complications. We intend to include randomized controlled trials (RCTs) with no language restrictions. We understand that due to the intervention's nature, it is impossible to have a cross-over study. If some authors find a way to produce such a review, we will use only the first arm. We will include RCTs where any spinal anesthesia and any drug were given before surgery to treat unintended anesthesia side effects. If there are no published RCTs, we will include adequate design cohort studies. Any age who received spinal anesthesia for surgery. We will consider for this review all kinds of spinal anesthesia with a local anesthetic used alone or combined with fentanyl or sufentanil or a combination of the first in human patients. PICO search terms: (P) Patients who received Spinal anesthesia ( I ) Sufentanil or Fentanyl Spinal anesthesia (C) bupivacaine or lidocaine, or levobupivacaine spinal anesthesia (O) Pain, PACU and hospital length, in-hospital mortality, respiratory depression, postoperative ileus, urinary retention, recovery from anesthesia, PONV, hypotension, block failure. Primary outcomes: 1. Pain in the postoperative period (measured by the number of episodes of postoperative pain (any numerical Rating Scale ≥3) at any time within 48 hours after the end of surgery and opioid consumption during the 48 hours postoperative 2. Length to discharge from the PACU and Hospital stay (measured in minutes, hours, or days) 3. In-hospital mortality if related to anesthesia (measured by the number of deaths between surgery and the hospital discharge) Secondary outcomes: 4. Block failure (need to supplement or change, any, dichotomic) 5. Respiratory depression (period, hypoxia and/or hypercarbia, aspiration, or need for ventilatory support) or postoperative hypoxemia (duration of oxygen therapeutic oxygen supplementation to maintain SpO2 >90% within the first 48 hours) 6. Hypotension (need for continuous vasopressors or ICU) 7. Urinary retention (number of participants necessary to use a bladder catheter to release between 48 hours after anesthesia) 8. Number of PONV episodes during the 48 hours following the surgical procedure (number of participants need for rescue antiemetic) 9. Pruritus 10. Shivering We intend to perform subgroup analysis if sufficient data is available for the following subgroups: 1) Types of surgery include cesarean, labor analgesia, lower limb surgery, gynecological, urological, orthopedic procedures, general surgery, and regular other procedures. 2) The surgical site is a lower member, transperitoneal, thoracic, abdominal, versus other sides.