Adenosine for postoperative analgesia: A systematic review and meta-analysisReportar como inadecuado




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Purpose

Perioperative infusion of adenosine has been suggested to reduce the requirement for inhalation anesthetics, without causing serious adverse effects in humans. We conducted a meta-analysis of randomized controlled trials evaluating the effect of adenosine on postoperative analgesia.

Methods

We retrieved articles in computerized searches of Scopus, Web of Science, PubMed, EMBASE, and Cochrane Library databases, up to July 2016. We used adenosine, postoperative analgesia, and postoperative pains as key words, with humans, RCT, and CCT as filters. Data of eligible studies were extracted, which included pain scores, cumulative opioid consumption, adverse reactions, and vital signs. Overall incidence rates, relative risk RR, and 95% confidence intervals CI were calculated employing fixed-effects or random-effects models, depending on the heterogeneity of the included trials.

Results

In total, 757 patients from 9 studies were included. The overall effect of adenosine on postoperative VAS-VRS scores and postoperative opioid consumption was not significantly different from that of controls P >0.1. The occurrence of PONV and pruritus was not statistically significantly different between an adenosine and nonremifentanil subgroup P >0.1, but the rate of PONV occurrence was greater in the remifentanil subgroup P <0.01. Time to first postoperative analgesic requirement in the adenosine group was not significantly difference from that of the saline group SMD = 0.07, 95%CI: −0.28 to 0.41, P = 0.71; but this occurred significantly later than with remifentanil SMD = 1.10, 95%CI: 2.48 to 4.06, P < 0.01. Time to hospital discharge was not significantly different between the control and adenosine groups P = 0.78. The perioperative systolic blood pressure was significantly lower in the adenosine than in the control group in the mannitol subgroup P < 0.01. The incidence of bradycardia, transient first- degree atrioventricular block, and tachycardia was not significantly different between the adenosine and control groups P > 0.1.

Conclusion

Adenosine has no analgesic effect or prophylactic effect against PONV, but reduce systolic blood pressure and heart rates. Adenosine may benefit patients with hypertension, ischemic heart disease, and tachyarrhythmia, thereby improving cardiac function.



Autor: Xin Jin , Weidong Mi

Fuente: http://plos.srce.hr/



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