Work

Efficacy of using intrathecal mu-receptor antagonist in preventing pruritus and PONV after spinal anesthesia – A systematic review and meta-analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: INTRODUCTION AND OBJECTIVE: Different adjuvants are used in combination with intrathecal local anesthesia to improve the quality of spinal anesthesia. Opioids are most used for this purpose, but these are associated with side effects such as pruritus and postoperative nausea and vomiting. Various medications have been utilized for prophylaxis or treatment of these side effects especially pruritus. Although mu-receptor antagonists are generally used intravenously or subcutaneously for the treatment of pruritus, few studies have investigated the role of intrathecal mu-receptor antagonists. So, this systematic review aimed to evaluate the effect of using intrathecal mu-receptor antagonists when used with local anesthetics like bupivacaine, and opioids for the prevention of opioid-related side effects. MATERIALS AND METHODS: This meta-analysis was conducted while following PRISMA guidelines. We registered this review with the PROSPERO database in February 2025. Two authors performed the literature searches in February 2025 and then repeated after one month to ensure accuracy. Two authors independently appraised the individual studies according to the Consolidated Standards of Reporting Trials checklist. Literature search was done using online databases including PubMed, Google Scholar, Science Direct and Cochrane library. Potential bias was evaluated using the risk of bias-2 (RoB-2) tool. We included randomized controlled trials that compared intrathecal mu-receptor antagonists with control for patients undergoing surgery under spinal anesthesia. The primary outcome of the study was the incidence of pruritus. We utilized the Review manager software, RevMan for MAC 5.4, to conduct the meta-analysis. Mean difference (MD), standard mean difference (SMD) and odds ratios (OR) were calculated for different outcomes. Using random effect models, Peto odd ratios were used for weighing models. Funnel plots and Egger's test were utilized to assess the risks for publication bias across studies. RESULTS: value for pruritus was 32% while it was 72% for PONV. There was no significant difference in VAS pain scores between two groups during the first 24 h except at 2 h postoperatively. Furthermore, the use of intrathecal mu-receptor antagonists did not significantly affect the time to first analgesic request. CONCLUSION: The use of intrathecal mu-receptor antagonists significantly reduces the occurrence of opioid-related side effects such as pruritus and PONV.

Source: Revista Española de Anestesiología y Reanimación (English Edition)

DOI: 10.1016/j.redare.2026.502034

Authors: A.U. Huda, R. Fernando, H.B. Ghafoor, R. Minhas

Institutions: Hamad Medical Corporation, Qatar University, King Khalid University Hospital

Language: English

Topic: Anesthesia and Pain Management

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $2,700