///2010 Abstract Details
2010 Abstract Details2018-05-01T17:52:49+00:00

Meta-analysis of the Efficacy of Epidural Naloxone in Decreasing Postoperative Pruritus and PONV

Abstract Number: 80
Abstract Type: Meta Analysis/Review of the Literature

Brandon Togioka MD1 ; Jamie D Murphy MD2; Harold Gelfand MD3; Cristianna Vallera MD4; Gillian Isaac MD, PhD5; Christopher Wu MD6

Objective: Pruritus and postoperative nausea and vomiting (PONV) may interfere with a parturients recovery after Cesarean section. Epidural naloxone has been used postoperatively in an attempt to decrease the incidence of pruritus and PONV; however, the overall efficacy of this intervention is uncertain. We have undertaken a systematic review to examine this issue.

Method: This study qualified for exemption from the Johns Hopkins IRB. Systematic literature searches of the National Library of Medicines PubMed and EMBASE databases were conducted using terms related to epidural naloxone. Only randomized controlled trials comparing epidural naloxone infusion to control (either saline infusion or no infusion) were included for analysis. Data on pertinent study characteristics and relevant outcomes were extracted from accepted articles. There was no restriction on language for inclusion. Meta-analysis was performed using the Review Manager 4.2.10 (The Cochrane Collaboration, 2004). A random effects model was used.

Results: The literature searches yielded 5 articles which met all inclusion criteria. There were a total of 172 subjects in the naloxone group and 126 subjects in the control group. The dosage of epidural naloxone ranged from 0.08 to 2 microgram/kg/hr. Use of epidural naloxone was associated with a significantly lower risk of PONV [relative risk (RR): 0.47 (95% CI: 0.28, 0.80)] and pruritus [RR: 0.46 (95% CI: 0.30, 0.73)]. There was no difference in visual analog (VAS) pain scores at 4-6 [Weighted mean difference (WMD): -0.29 (95% CI: -0.76, 0.18)] and 8-12 hours [WMD: -0.52 (95% CI: -1.27, 0.22)] postoperatively.

Conclusions: Our pooled analysis examining the efficacy of epidural naloxone revealed that this intervention is efficacious in reducing postoperative pruritus and PONV without any change in analgesia. However, the results should be interpreted with caution as the overall number of subjects is relatively small and particularly considering the fact that the safety and neurotoxic profile of naloxone via the epidural route has not been fully examined.

SOAP 2010