ABSTRACT
OBJECTIVE: Perioperative shivering (POS) is a common complication in patients undergoing spinal anaesthesia. The present study investigated the efficacy of 5-HT3 receptor antagonists in preventing POS following spinal anaesthesia. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Pubmed, Embase, the Web of Science and Cochrane Library were searched from database establishment on 31 July 2019. ELIGIBILITY CRITERIA: Randomised controlled trials that reported the effects of 5-HT3 receptor antagonists in the prevention of POS in patients after spinal anaesthesia. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data. The primary outcome of the present study was the incidence of POS. The risk of bias for the included studies was assessed according to the Cochrane Handbook. The quality of primary outcome was evaluated by Grading of Recommendations Assessment, Development and Evaluation. Trial sequential analysis for the primary outcome was performed to reduce the type 1 error caused by repeated meta-analysis and the required information size was calculated. RESULTS: A total of 13 randomised controlled trials consisting of 1139 patients were included. The overall incidence of POS was significantly lower in the 5-HT3 receptor antagonists group (risk ratio 0.31; 95% CI 0.26 to 0.38; p<0.01; I2=0%). Subgroup analysis for different types of 5-HT3 receptor antagonists and timing of administration produced similar results. Also, patients had a lower incidence of postoperative nausea and vomiting after administrating 5-HT3 receptor antagonists. No statistically significant differences in drug-related adverse effects were observed. Grading of Recommendations Assessment, Development and Evaluation revealed a high level of evidence. The cumulative z-curve crossed the trial sequential monitoring boundary. CONCLUSIONS: The present study revealed that prophylactic 5-HT3 receptor antagonists were an effective measure for reducing the incidence of POS in patients after spinal anaesthesia. However, further studies investigating the different types of surgeries are required. PROSPERO REGISTRATION NUMBER: CRD42019148191.
Subject(s)
Anesthesia, Spinal , Pharmaceutical Preparations , Anesthesia, Spinal/adverse effects , Humans , Postoperative Nausea and Vomiting , Randomized Controlled Trials as Topic , Serotonin , ShiveringABSTRACT
OBJECTIVE: Previous studies reported the effect of dexmedetomidine on intrathecal anesthesia. In this review, we explored the impact of dexmedetomidine as an adjunct for lumbar anesthesia in patients undergoing cesarean section. METHODS: Two authors searched eligible random controlled trials in electronic databases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, the Chinese BioMedical database, Chinese Scientific Journal Database, and the Wanfang database. RESULTS: Ten trials comprising 970 patients were included in this review. Intrathecal dexmedetomidine significantly reduced the onset time of sensory block (standardized mean difference (SMD), -1.50, 95% confidence interval (CI) -2.15, -0.85, I2 = 92%) and motor block (SMD -0.77, 95% CI -1.50, -0.49, I2 = 60%) and prolonged the block duration time (sensory block: SMD 2.02, 95% CI 1.29, 2.74, I2 = 93%; motor block: SMD 1.90, 95% CI 1.07, 2.74, I2 = 94%). Patients who received dexmedetomidine showed a lower incidence of shivering. No significant difference was reported for the neonatal Apgar score and other complications. CONCLUSION: The use of intrathecal dexmedetomidine during cesarean section can shorten the onset time of spinal anesthesia and enhance the effect of local anesthetic. It has no significant impact on neonates and there were no other adverse events.
Subject(s)
Anesthesia, Obstetrical/methods , Anesthesia, Spinal/methods , Anesthetics, Local/administration & dosage , Cesarean Section/adverse effects , Dexmedetomidine/administration & dosage , Anesthesia, Obstetrical/adverse effects , Anesthesia, Spinal/adverse effects , Anesthetics, Local/adverse effects , Dexmedetomidine/adverse effects , Female , Humans , Infant, Newborn , Pain, Procedural/etiology , Pain, Procedural/prevention & control , Pregnancy , Time FactorsSubject(s)
Delirium/blood , Delirium/etiology , Melatonin/blood , Postoperative Complications/blood , Abdomen/surgery , Age Factors , Aged , Biomarkers , Critical Care , Delirium/diagnosis , Female , Humans , Male , Risk FactorsABSTRACT
Peripheral nerve injury induces the cleavage of CX3CL1 from the membrane of neurons, where the soluble CX3CL1 subsequently plays an important role in the transmission of nociceptive signals between neurons and microglia. Here we investigated whether CX3CL1 regulates microglia activation through the phosphorylation of extracellular signal-regulated protein kinase 5 (ERK5) in the spinal cord of rats with spinal nerve ligation (SNL). ERK5 and microglia were activated in the spinal cord after SNL. The knockdown of ERK5 by intrathecal injection of antisense oligonucleotides suppressed the hyperalgesia and nuclear impact of nuclear factor-κB induced by SNL. The blockage of CX3CR1, the receptor of CX3CL1, significantly reduced the level of ERK5 activation following SNL. In addition, the antisense knockdown of ERK5 reversed the CX3CL1-induced hyperalgesia and spinal microglia activation. Our study suggests that CX3CL1/CX3CR1 regulates nerve injury-induced pain hypersensitivity through the ERK5 signaling pathway.
