Barrons Robert W, Woods Joseph Andrew
Department of Pharmacy, Wingate University School of Pharmacy, Wingate, North Carolina.
Pharmacotherapy. 2017 May;37(5):546-554. doi: 10.1002/phar.1930. Epub 2017 May 9.
To determine whether postoperative administration of low-dose intravenous naloxone decreases the incidence of postoperative nausea and vomiting (PONV) and its impact on postoperative opioid requirements and pain scores.
Meta-analysis of nine randomized controlled trials.
A total of 946 adult and pediatric patients who received low-dose intravenous naloxone for 24 hours after various surgeries.
Systemic literature searches of the Cochrane Central Register of Controlled Trials, Evidence-Based Medicine Reviews, PubMed, and Ovid MEDLINE databases were conducted. Among the relevant studies, data extraction and bias assessment determined the trials for inclusion in this meta-analysis. Nine randomized controlled trials met inclusion criteria. Naloxone demonstrated a reduced risk of postoperative nausea (risk ratio [RR] 0.80, 95% confidence interval [CI] 0.67-0.95, p=0.01) in a pooled analysis of eight of the nine studies. However, naloxone did not decrease the risk of postoperative vomiting in a collective assessment of all nine trials (RR 0.83, 95% CI 0.63-1.09, p=0.18). Subgroup analysis of continuous-infusion naloxone found further reductions in nausea and vomiting, but these findings were limited to 186 of the 946 patients. Three studies recorded antiemetic doses and found an overall dose reduction (RR 0.64, 95% CI 0.42-0.96, p=0.03). Compared with controls, naloxone prophylaxis of PONV did not significantly change cumulative postoperative opioid needs (mean difference 0.29 mg, 95% CI -3.55 to 4.13 mg, p=0.88) among five trials, nor visual analog scale pain scores (mean difference -0.11, 95% CI -0.26 to 0.05, p=0.18) in six studies.
This pooled analysis of data suggests that low-dose naloxone plays no role in preventing PONV, while exhibiting no significant effects on postoperative opioid needs and pain scores. The reduction demonstrated in postoperative nausea did not translate into decreases in postoperative vomiting.
确定术后给予低剂量静脉注射纳洛酮是否能降低术后恶心呕吐（PONV）的发生率及其对术后阿片类药物需求和疼痛评分的影响。
对9项随机对照试验进行荟萃分析。
共有946例成年和儿科患者在接受各种手术后接受了24小时的低剂量静脉注射纳洛酮。
对Cochrane对照试验中央注册库、循证医学评论、PubMed和Ovid MEDLINE数据库进行了全面的文献检索。在相关研究中，通过数据提取和偏倚评估确定纳入本荟萃分析的试验。9项随机对照试验符合纳入标准。在9项研究中的8项的汇总分析中，纳洛酮显示术后恶心风险降低（风险比[RR]0.80，95%置信区间[CI]0.67-0.95，p=0.01）。然而，在对所有9项试验的综合评估中，纳洛酮并未降低术后呕吐的风险（RR 0.83，95%CI 0.63-1.09，p=0.18）。对持续输注纳洛酮的亚组分析发现恶心和呕吐进一步减少，但这些发现仅限于946例患者中的186例。3项研究记录了止吐剂量，发现总体剂量减少（RR 0.64，95%CI 0.42-0.96，p=0.03）。与对照组相比，纳洛酮预防PONV在5项试验中并未显著改变术后阿片类药物的累积需求量（平均差异0.29mg，95%CI -3.55至4.13mg，p=0.88），在6项研究中也未改变视觉模拟量表疼痛评分（平均差异-0.11，95%CI -0.26至0.05，p=0.18）。
该汇总数据分析表明，低剂量纳洛酮在预防PONV方面不起作用，同时对术后阿片类药物需求和疼痛评分无显著影响。术后恶心的减少并未转化为术后呕吐的减少。
