BJA Advance Access published online on July 7, 2008
British Journal of Anaesthesia, doi:10.1093/bja/aen202
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Effect of prophylactic 5-HT3 receptor antagonists on pruritus induced by neuraxial opioids: a quantitative systematic review
1 Département d'Anesthésie-Réanimation, Groupe Hospitalier Paris Sud, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Clamart, France
2 Département d'Anesthésie-Réanimation, Groupe Hospitalier Tenon, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
* Corresponding author. E-mail: marie-pierre.bonnet{at}abc.aphp.fr
Pruritus is a frequent adverse event observed after neuraxial administration of opioids. Central 5-hydroxytryptamine subtype 3 (5-HT3) receptors may be activated in this process. This systematic review aimed to evaluate the efficacy of prophylactic 5-HT3 receptor antagonists on neuraxial opioid-induced pruritus. We searched Medline, Embase, and Cochrane Collaboration Library databases. Studies were evaluated with the Oxford Validity Scale. Studies with a score of 3 or more and reporting prophylactic administration of 5-HT3 receptor antagonists vs placebo were included. Fifteen randomized double-blind controlled trials (n=1337) were selected. 5-HT3 antagonists (n=775) significantly reduced pruritus [odds ratio (OR) 0.44 (95% confidence interval, 95% CI, 0.29–0.68), P=0.0002, number-needed-to-treat (NNT) 6 (95% CI, 4–14)], the treatment request for pruritus [OR 0.58 (95% CI, 0.43–0.78), P=0.0003, NNT 10 (95% CI, 7–20)], the intensity of pruritus [weighted mean difference (WMD) –0.35 (95% CI, –0.59 to –0.10), P=0.007], the incidence and the intensity of postoperative nausea and vomiting (PONV), and the need of rescue treatment [respectively, Peto odds ratio (Peto OR) 0.43 (95% CI, 0.31–0.58), P<0.00001, NNT 7 (95% CI, 6–10); WMD –0.12 (95% CI, –0.24 to 0.00), P=0.05 and OR 0.42 (95% CI, 0.20–0.86), P=0.02, NNT 8 (95% CI, 5–35)]. However, the funnel plot was asymmetric, suggesting a risk of publication bias. 5-HT3 receptor antagonists may be an effective strategy in preventing neuraxial opioid-induced pruritus and PONV. Further large randomized controlled trials are required to confirm these findings.
Keywords: analgesics opioid; analgesic techniques, subarachnoid; complications, pruritus; pharmacology, 5-HT antagonists; vomiting, antiemetics
This study has been presented during the 49th Congress of the Société Française d'Anesthésie-Réanimation, Paris, France, September 27, 2007.
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