Fentanyl Or Sufentanil Plus Bupivacaine Versus Bupivacaine Alone For Spinal Anesthesia In Patients Undergoing Cesarean Section:a Meta-analysis Of Randomized Trials

Objective:Intrathecal anesthesia is a popular technique for cesarean delivery. Addition of opioids to local anesthetics for intrathecal anesthesia has also become a widely used practice for cesarean delivery. However, the benefits and risks of the addition of opioids remain unclear. Therefore, we conducted a meta-analysis to quantify the benefits of the addition of fentanyl or sufentanil to bupivacaine in patients undergoing cesarian delivery.Methods:A comprehensive literature search was conducted to identify clinical trials that compared the addition of fentanyl or sufentanil to bupivacaine with bupivacaine alone for spinal anesthesia in healthy parturients undergoing cesarean delivery. The search collected trials from Pubmed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science. Data from each trial were combined using relative ratios (RR) for dichotomous data or weighted mean differences (WMD) for continuous data and corresponding95%confidence intervals (95%CI) for each trial.The Q and I2tests were used to assess heterogeneity. Sensitivity analysis was conducted by removing each study individually to assess the quality and consistency of the results. Begg’s funnel plots and Egger’s linear regression test were used to detect any publication bias. Results:Meta-analysis included12trials in the final analysis. Added opioids provided a better analgesia quality with less breakthrough pain during surgery than bupivacaine alone (RR=0.109,95%CI=[0.067,0.178], P<0.001). Sensory block onset time was shortened and duration was prolonged in the added opioid group compared to that in the bupivacaine alone group(WMD=-0.98min,95%CI=[-1.42,-0.55], P<0.001; and WMD=162min,95%CI=[112,213], P<0.001, respectively). In addition, there was no significant difference in incidences of hypotension, nausea, vomiting. Prurituswas a frequent side effect when opioid was added (RR=6.926,95%CI4.0129and11.907, P=0.000).Conclusion:Use of fentanyl or sufentanil plus bupivacaine is superior to that of bupivacaine alone for intrathecal anesthesia for cesarean delivery. The main effects were a better analgesia quality, shortened sensory block onset time, prolonged sensory block duration. However, the addition of fentanyl or sufentanil to bupivacaine increased the incidence of pruritus.