| Objective: To evaluate the efficacy of fentanyl and its derivatives on the preventive effects of emergence agitation(EA) in children under sevoflurane anesthesia, we conducted a meta-analysis.Methods: According to the search strategies, the Chinese or English articles published in Pubmed, EMBASE, The Cochrane Library, Chinese Biomedical Literature Database, Chinese Journals Full-text database, Wan Fang Database and VIP Database were searched up to November 2015. All randomized clinical trials(RCTs) comparing fentanyl and its derivatives with placebo interventions in preventing sevoflurane-related EA of children were retrieved and estimated for qualities by the modified Jadad scale. The statistical software Rev Man 5.3 was used for meta-analysis. Data from each study were combined using the relative ratio(RR), weighted mean differences(WMD) and their associated 95% confidence intervals(CIs). I2>40% and P<0.1 were used to indicate heterogeneity. Publication bias was checked using funnel plots and Begg’s test.Results: The meta-analysis showed the inclusion of 20 randomized controlled trials with 1568 patients(877 received fentanyl and its derivatives therapy and 691 had placebo). The methodological quality of the included literature was relatively high. In terms of EA incidence in the fentanyl group, a possibility of publication bias was detected. The results of meta-analyses showed that:1. Primary outcomeEA incidence: Compared to the control group, fentanyl, remifentanil, sufentanil and alfentanil groups exerted a preventive effect on EA in children [RR=0.49, 95%CI(0.38, 0.64), P<0.00001; RR=0.55, 95%CI(0.37, 0.81), P=0.003; RR=0.17, 95%CI(0.08, 0.35), P<0.0001; RR=0.56, 95%CI(0.41, 0.78), P=0.0005]. And, the EA incidence in the sufentanil group was lower than the equivalent dose of fentanyl group [RR=0.20, 95%CI(0.07, 0.54), P=0.002].2. Second outcome:2.1 Extubation time: Compared to the control group, no significant differences were observed in the fentanyl, remifentanil and sufentanil groups [RR=0.56, 95%CI(-0.06, 1.19), P=0.08; RR=-0.11, 95%CI(-1.14, 0.92), P=0.83; RR=0.45, 95%CI(-0.81, 1.70), P=0.48].2.2 Emergence time: Compared to the control group, emergence time was longer in the fentanyl group [RR=1.41, 95%CI(0.31, 2.52), P=0.01]. While no significant difference was found between the remifentanil group and the control group [RR=-3.17, 95%CI(-6.48, 0.14), P=0.06].2.3 The duration of stay at PACU: Compared to the control group, no significant differences were found in the fentanyl, remifentanil and sufentanil groups [RR=0.38, 95%CI(-1.70, 2.45), P=0.72; 95%CI(-15.33, 2.50), P=0.16; RR=-7.06, 95%CI(-18.71, 4.60), P=0.24].2.4 Postoperative pain incidence: Compared to the control group, the postoperative pain incidence was lower in the fentanyl group [RR=0.64,95%CI(0.41, 0.99), P=0.05].2.5 PONV incidence: Compared to the control group, the PONV incidence was higher in the fentanyl group [RR=2.00, 95%CI(1.30, 2.50), P=3.07].Conclusion: According to the existing evidence, prophylactic fentanyl, remifentanil, sufentanil and alfentanil could significantly decrease the EA incidence under sevoflurane anesthesia in children. And, sufentanil was better in preventing EA than the equivalent dose of fentanyl. In additional, fentanyl, remifentanil and sufentanil did not prolong the extubation time and duration of stay at PACU. Fentanyl could decrease the postoperative pain incidence, prolong the emergence time and increase the PONV incidence. However, considering the quantity of the included studies, the above conclusion should be verified by conducting larger sample, multi-center and higher quality RCTs. |
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