Yousefifard Mahmoud, Vazirizadeh-Mahabadi Mohammad Hossein, Neishaboori Arian Madani, Alavi Seyedeh Niloufar Rafiei, Amiri Marzieh, Baratloo Alireza, Saberian Peyman
Physiology Research Center, Iran University of Medical Sciences, Tehran Iran.
Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Adv J Emerg Med. 2019 Nov 16;4(2):e27. doi: 10.22114/ajem.v0i0.279. eCollection 2020 Spring.
The present systematic review and meta-analysis aims to perform an extensive search in databases to compare the efficacy of the intranasal administration of naloxone with its intramuscular/intravenous administration in the pre-hospital management of opioid overdose.
This meta-analysis included controlled trials conducted on the efficacy of naloxone administration in the pre-hospital management of opioid overdose. A search was carried out in electronic databases on relevant articles published by the end of 2018. After data collection, analyses were performed in STATA 14.0 software and the efficacy and side-effects of the two administration routes of naloxone, i.e. intranasal and intramuscular/intravenous, were compared. An overall effect size with 95% confidence interval (95% CI) was provided for each section.
Eventually, data from six studies were included in this meta-analysis. The success rate of the intranasal and intramuscular/intravenous administration of naloxone in the management of opioid overdose in pre-hospital settings was 82.54% (95% CI: 57.97 to 97.89%) and 80.39% (95% CI: 57.38 to 96.04%), respectively. There was no difference between injectable (intramuscular/intravenous) naloxone and intranasal naloxone in the pre-hospital management of opioid overdose (Odds Ratio=1.01; 95% CI: 0.42 to 2.43; P=0.98). The onset of action of intranasal naloxone, however, was slightly longer than injectable naloxone (Standardized Mean Difference=0.63; 95% CI: 0.07 to 1.19; P=0.03). Additionally, the odds of needing a rescue dose was 2.17 times higher for intranasal naloxone than intramuscular/intravenous naloxone (OR=2.17; 95% CI: 1.53 to 3.09; P<0.0001). The prevalence of major side-effects was non-significant for both intranasal (0.00%) and intramuscular/intravenous (0.05%) routes of naloxone administration and there was no difference in the prevalence of major (OR=1.18; 95% CI: 0.38 to 3.69; P=0.777) and minor (OR=0.64; 95% CI: 0.17 to 2.34; P=0.497) side-effects between the two routes.
The present meta-analysis demonstrated that intranasal naloxone is as effective as injectable naloxone in the pre-hospital management of opioid overdose complications. Consequently, intranasal naloxone may be an appropriate alternative to injectable naloxone.
本系统评价和荟萃分析旨在广泛检索数据库，以比较在阿片类药物过量的院前管理中，经鼻给予纳洛酮与肌肉注射/静脉注射纳洛酮的疗效。
本荟萃分析纳入了关于纳洛酮在阿片类药物过量院前管理中疗效的对照试验。检索了截至2018年底电子数据库中发表的相关文章。数据收集后，使用STATA 14.0软件进行分析，并比较了纳洛酮两种给药途径（即经鼻和肌肉注射/静脉注射）的疗效和副作用。为每个部分提供了95%置信区间（95%CI）的总体效应量。
最终，六项研究的数据纳入了本荟萃分析。在院前环境中，经鼻和肌肉注射/静脉注射纳洛酮治疗阿片类药物过量的成功率分别为82.54%（95%CI：57.97至97.89%）和80.39%（95%CI：57.38至96.04%）。在阿片类药物过量的院前管理中，注射用（肌肉注射/静脉注射）纳洛酮和经鼻纳洛酮之间没有差异（优势比=1.01；95%CI：0.42至2.43；P=0.98）。然而，经鼻纳洛酮的起效时间略长于注射用纳洛酮（标准化均数差=0.63；95%CI：0.07至1.19；P=0.03）。此外，经鼻纳洛酮需要抢救剂量的几率比肌肉注射/静脉注射纳洛酮高2.17倍（OR=2.17；95%CI：1.53至3.09；P<0.0001）。纳洛酮经鼻给药（0.00%）和肌肉注射/静脉注射给药（0.05%）的主要副作用发生率均无统计学意义，两种给药途径在主要（OR=1.18；95%CI：0.38至3.69；P=0.777）和次要（OR=0.64；95%CI：0.17至2.34；P=0.497）副作用发生率上没有差异。
本荟萃分析表明，在阿片类药物过量并发症的院前管理中，经鼻纳洛酮与注射用纳洛酮同样有效。因此，经鼻纳洛酮可能是注射用纳洛酮的合适替代方案。
