Combination of Low‐Dose Bupivacaine and Opioids Provides Satisfactory Analgesia with Less Intraoperative Hypotension for Spinal Anesthesia in Cesarean Section
Identifieur interne : 000694 ( Istex/Corpus ); précédent : 000693; suivant : 000695Combination of Low‐Dose Bupivacaine and Opioids Provides Satisfactory Analgesia with Less Intraoperative Hypotension for Spinal Anesthesia in Cesarean Section
Auteurs : Man-Tang Qiu ; Fu-Qing Lin ; Shu-Kun Fu ; Heng-Bin Zhang ; Hui-Hua Li ; Li-Ming Zhang ; Quan LiSource :
- CNS Neuroscience & Therapeutics [ 1755-5930 ] ; 2012-05.
English descriptors
- KwdEn :
- Analgesia, Analgesic, Anesth, Anesth analg, Anesthesia, Baseline, Blackwell publishing, Blood pressure, Bupivacaine, Caesarean, Caesarean section, Cesarean, Cesarean delivery, Cesarean section, Eligible trials, Ephedrine, Epidural anesthesia, Fentanyl, Heterogeneity, Hypotension, Intraoperative, Intraoperative analgesia, Intraoperative hypotension, Intrathecal, Intrathecal bupivacaine, Introoperative, Introoperative analgesia, Introoperative analgesiab, Maternal hypotension, Meperidine, Neuroscience, Neuroscience therapeutics, Opioids, Original study data, Parturients, Primary endpoints, Publishing time, Regimen, Reliable analgesia, Spinal, Spinal anesthesia, Therapeutics, Total dose.
- Teeft :
- Analgesia, Analgesic, Anesth, Anesth analg, Anesthesia, Baseline, Blackwell publishing, Blood pressure, Bupivacaine, Caesarean, Caesarean section, Cesarean, Cesarean delivery, Cesarean section, Eligible trials, Ephedrine, Epidural anesthesia, Fentanyl, Heterogeneity, Hypotension, Intraoperative, Intraoperative analgesia, Intraoperative hypotension, Intrathecal, Intrathecal bupivacaine, Introoperative, Introoperative analgesia, Introoperative analgesiab, Maternal hypotension, Meperidine, Neuroscience, Neuroscience therapeutics, Opioids, Original study data, Parturients, Primary endpoints, Publishing time, Regimen, Reliable analgesia, Spinal, Spinal anesthesia, Therapeutics, Total dose.
Abstract
SUMMARY Aims: This meta‐analysis was undertaken to compare the three most common drug regimens of bupivacaine in spinal anesthesia for cesarean section: high‐dose bupivacaine (≥10 mg, HB), low‐dose bupivacaine (<10 mg, LB) and combination of low‐dose bupivacaine and opioids (LBO). Methods: Databases of MEDLINE, EMBASE, and Cochrane Library were searched (updated on October 30, 2011). Primary endpoints were the incidence of intraoperative hypotension and analgesia efficacy. Pooled risk ratio (RR) or standard mean difference and their 95% confidence intervals (95% CI) were calculated. A RR <1 indicates that LB or LBO regimen is associated with less intraoperative complications and better anesthesia or analgesia efficacy. Results: A total of 11 randomized controlled trials including 605 parturients were analyzed. Results of this meta‐analysis showed that compared with HB regimen, LB regimen decreased the incidence of intraoperative hypotension (RR = 0.64, 95% CI: 0.42–0.96) with less satisfactory analgesia (fixed model, RR = 1.50, 95% CI: 1.14–1.98). LBO regimen significantly reduced the incidence of intraoperative hypotension (RR = 0.52, 95% CI: 0.33–0.82) with reliable analgesia efficacy (RR = 2.56, 95% CI: 0.77–8.48). Conclusion: Compared with conventional HB regimen and LB regimen, LBO regimen not only reduced intraoperative hypotension but also provided reliable analgesia. Therefore, LBO regimen should be considered as the preferred drug combination for spinal anesthesia in cesarean section.
Url:
DOI: 10.1111/j.1755-5949.2012.00306.x
Links to Exploration step
ISTEX:1E06A598D21218A1EA9ABF0C627AAD543CBA2295Le document en format XML
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China</mods:affiliation></affiliation></author><author><name sortKey="Fu, Shu Un" sort="Fu, Shu Un" uniqKey="Fu S" first="Shu-Kun" last="Fu">Shu-Kun Fu</name><affiliation><mods:affiliation>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China</mods:affiliation></affiliation></author><author><name sortKey="Zhang, Heng In" sort="Zhang, Heng In" uniqKey="Zhang H" first="Heng-Bin" last="Zhang">Heng-Bin Zhang</name><affiliation><mods:affiliation>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China</mods:affiliation></affiliation><affiliation><mods:affiliation>First Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China</mods:affiliation></affiliation></author><author><name sortKey="Li, Hui Ua" sort="Li, Hui Ua" uniqKey="Li H" first="Hui-Hua" last="Li">Hui-Hua Li</name><affiliation><mods:affiliation>Department of Anaesthesiology, University of 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Fu Ing" uniqKey="Lin F" first="Fu-Qing" last="Lin">Fu-Qing Lin</name><affiliation><mods:affiliation>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China</mods:affiliation></affiliation></author><author><name sortKey="Fu, Shu Un" sort="Fu, Shu Un" uniqKey="Fu S" first="Shu-Kun" last="Fu">Shu-Kun Fu</name><affiliation><mods:affiliation>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China</mods:affiliation></affiliation></author><author><name sortKey="Zhang, Heng In" sort="Zhang, Heng In" uniqKey="Zhang H" first="Heng-Bin" last="Zhang">Heng-Bin Zhang</name><affiliation><mods:affiliation>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China</mods:affiliation></affiliation><affiliation><mods:affiliation>First Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China</mods:affiliation></affiliation></author><author><name sortKey="Li, Hui Ua" sort="Li, Hui Ua" uniqKey="Li H" first="Hui-Hua" last="Li">Hui-Hua Li</name><affiliation><mods:affiliation>Department of Anaesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA</mods:affiliation></affiliation></author><author><name sortKey="Zhang, Li Ing" sort="Zhang, Li Ing" uniqKey="Zhang L" first="Li-Ming" last="Zhang">Li-Ming Zhang</name><affiliation><mods:affiliation>Department of Anaesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA</mods:affiliation></affiliation></author><author><name sortKey="Li, Quan" sort="Li, Quan" uniqKey="Li Q" first="Quan" last="Li">Quan Li</name><affiliation><mods:affiliation>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">CNS Neuroscience & Therapeutics</title><title level="j" type="alt">CNS NEUROSCIENCE THERAPEUTICS</title><idno type="ISSN">1755-5930</idno><idno type="eISSN">1755-5949</idno><imprint><biblScope unit="vol">18</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="426">426</biblScope><biblScope unit="page" to="432">432</biblScope><biblScope unit="page-count">7</biblScope><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2012-05">2012-05</date></imprint><idno type="ISSN">1755-5930</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1755-5930</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Analgesia</term><term>Analgesic</term><term>Anesth</term><term>Anesth analg</term><term>Anesthesia</term><term>Baseline</term><term>Blackwell publishing</term><term>Blood pressure</term><term>Bupivacaine</term><term>Caesarean</term><term>Caesarean section</term><term>Cesarean</term><term>Cesarean delivery</term><term>Cesarean section</term><term>Eligible trials</term><term>Ephedrine</term><term>Epidural anesthesia</term><term>Fentanyl</term><term>Heterogeneity</term><term>Hypotension</term><term>Intraoperative</term><term>Intraoperative analgesia</term><term>Intraoperative hypotension</term><term>Intrathecal</term><term>Intrathecal bupivacaine</term><term>Introoperative</term><term>Introoperative analgesia</term><term>Introoperative analgesiab</term><term>Maternal hypotension</term><term>Meperidine</term><term>Neuroscience</term><term>Neuroscience therapeutics</term><term>Opioids</term><term>Original study data</term><term>Parturients</term><term>Primary endpoints</term><term>Publishing time</term><term>Regimen</term><term>Reliable analgesia</term><term>Spinal</term><term>Spinal anesthesia</term><term>Therapeutics</term><term>Total dose</term></keywords><keywords scheme="Teeft" xml:lang="en"><term>Analgesia</term><term>Analgesic</term><term>Anesth</term><term>Anesth analg</term><term>Anesthesia</term><term>Baseline</term><term>Blackwell publishing</term><term>Blood pressure</term><term>Bupivacaine</term><term>Caesarean</term><term>Caesarean section</term><term>Cesarean</term><term>Cesarean delivery</term><term>Cesarean section</term><term>Eligible trials</term><term>Ephedrine</term><term>Epidural anesthesia</term><term>Fentanyl</term><term>Heterogeneity</term><term>Hypotension</term><term>Intraoperative</term><term>Intraoperative analgesia</term><term>Intraoperative hypotension</term><term>Intrathecal</term><term>Intrathecal bupivacaine</term><term>Introoperative</term><term>Introoperative analgesia</term><term>Introoperative analgesiab</term><term>Maternal hypotension</term><term>Meperidine</term><term>Neuroscience</term><term>Neuroscience therapeutics</term><term>Opioids</term><term>Original study data</term><term>Parturients</term><term>Primary endpoints</term><term>Publishing time</term><term>Regimen</term><term>Reliable analgesia</term><term>Spinal</term><term>Spinal anesthesia</term><term>Therapeutics</term><term>Total dose</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract">SUMMARY Aims: This meta‐analysis was undertaken to compare the three most common drug regimens of bupivacaine in spinal anesthesia for cesarean section: high‐dose bupivacaine (≥10 mg, HB), low‐dose bupivacaine (<10 mg, LB) and combination of low‐dose bupivacaine and opioids (LBO). Methods: Databases of MEDLINE, EMBASE, and Cochrane Library were searched (updated on October 30, 2011). Primary endpoints were the incidence of intraoperative hypotension and analgesia efficacy. Pooled risk ratio (RR) or standard mean difference and their 95% confidence intervals (95% CI) were calculated. A RR <1 indicates that LB or LBO regimen is associated with less intraoperative complications and better anesthesia or analgesia efficacy. Results: A total of 11 randomized controlled trials including 605 parturients were analyzed. Results of this meta‐analysis showed that compared with HB regimen, LB regimen decreased the incidence of intraoperative hypotension (RR = 0.64, 95% CI: 0.42–0.96) with less satisfactory analgesia (fixed model, RR = 1.50, 95% CI: 1.14–1.98). LBO regimen significantly reduced the incidence of intraoperative hypotension (RR = 0.52, 95% CI: 0.33–0.82) with reliable analgesia efficacy (RR = 2.56, 95% CI: 0.77–8.48). Conclusion: Compared with conventional HB regimen and LB regimen, LBO regimen not only reduced intraoperative hypotension but also provided reliable analgesia. Therefore, LBO regimen should be considered as the preferred drug combination for spinal anesthesia in cesarean section.</div></front></TEI><istex><corpusName>wiley</corpusName><keywords><teeft><json:string>bupivacaine</json:string><json:string>hypotension</json:string><json:string>anesthesia</json:string><json:string>analgesia</json:string><json:string>spinal</json:string><json:string>spinal anesthesia</json:string><json:string>intraoperative</json:string><json:string>cesarean</json:string><json:string>fentanyl</json:string><json:string>regimen</json:string><json:string>cesarean section</json:string><json:string>heterogeneity</json:string><json:string>opioids</json:string><json:string>intrathecal</json:string><json:string>ephedrine</json:string><json:string>caesarean</json:string><json:string>anesth</json:string><json:string>parturients</json:string><json:string>meperidine</json:string><json:string>intraoperative analgesia</json:string><json:string>analgesic</json:string><json:string>therapeutics</json:string><json:string>blackwell publishing</json:string><json:string>maternal hypotension</json:string><json:string>neuroscience therapeutics</json:string><json:string>caesarean section</json:string><json:string>introoperative</json:string><json:string>neuroscience</json:string><json:string>blood pressure</json:string><json:string>intraoperative hypotension</json:string><json:string>original study data</json:string><json:string>cesarean delivery</json:string><json:string>anesth analg</json:string><json:string>baseline</json:string><json:string>eligible trials</json:string><json:string>introoperative analgesia</json:string><json:string>epidural anesthesia</json:string><json:string>publishing time</json:string><json:string>reliable analgesia</json:string><json:string>introoperative analgesiab</json:string><json:string>primary endpoints</json:string><json:string>total dose</json:string><json:string>intrathecal bupivacaine</json:string></teeft></keywords><author><json:item><name>Man‐Tang Qiu</name><affiliations><json:string>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China</json:string><json:string>First Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China</json:string></affiliations></json:item><json:item><name>Fu‐Qing Lin</name><affiliations><json:string>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China</json:string></affiliations></json:item><json:item><name>Shu‐Kun Fu</name><affiliations><json:string>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China</json:string></affiliations></json:item><json:item><name>Heng‐Bin Zhang</name><affiliations><json:string>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China</json:string><json:string>First Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China</json:string></affiliations></json:item><json:item><name>Hui‐Hua Li</name><affiliations><json:string>Department of Anaesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA</json:string></affiliations></json:item><json:item><name>Li‐Ming Zhang</name><affiliations><json:string>Department of Anaesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA</json:string></affiliations></json:item><json:item><name>Quan Li</name><affiliations><json:string>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Bupivacaine</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Cesarean section</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Hypotension</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Opioids</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Spinal anesthesia</value></json:item></subject><articleId><json:string>CNS306</json:string></articleId><arkIstex>ark:/67375/WNG-LQX6MFGH-7</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>article</json:string></originalGenre><abstract>SUMMARY Aims: This meta‐analysis was undertaken to compare the three most common drug regimens of bupivacaine in spinal anesthesia for cesarean section: high‐dose bupivacaine (≥10 mg, HB), low‐dose bupivacaine (>10 mg, LB) and combination of low‐dose bupivacaine and opioids (LBO). Methods: Databases of MEDLINE, EMBASE, and Cochrane Library were searched (updated on October 30, 2011). Primary endpoints were the incidence of intraoperative hypotension and analgesia efficacy. Pooled risk ratio (RR) or standard mean difference and their 95% confidence intervals (95% CI) were calculated. A RR >1 indicates that LB or LBO regimen is associated with less intraoperative complications and better anesthesia or analgesia efficacy. Results: A total of 11 randomized controlled trials including 605 parturients were analyzed. Results of this meta‐analysis showed that compared with HB regimen, LB regimen decreased the incidence of intraoperative hypotension (RR = 0.64, 95% CI: 0.42–0.96) with less satisfactory analgesia (fixed model, RR = 1.50, 95% CI: 1.14–1.98). LBO regimen significantly reduced the incidence of intraoperative hypotension (RR = 0.52, 95% CI: 0.33–0.82) with reliable analgesia efficacy (RR = 2.56, 95% CI: 0.77–8.48). Conclusion: Compared with conventional HB regimen and LB regimen, LBO regimen not only reduced intraoperative hypotension but also provided reliable analgesia. Therefore, LBO regimen should be considered as the preferred drug combination for spinal anesthesia in cesarean section.</abstract><qualityIndicators><refBibsNative>true</refBibsNative><abstractWordCount>216</abstractWordCount><abstractCharCount>1519</abstractCharCount><keywordCount>5</keywordCount><score>8.388</score><pdfWordCount>3796</pdfWordCount><pdfCharCount>24494</pdfCharCount><pdfVersion>1.3</pdfVersion><pdfPageCount>7</pdfPageCount><pdfPageSize>595.274 x 782.286 pts</pdfPageSize></qualityIndicators><title>Combination of Low‐Dose Bupivacaine and Opioids Provides Satisfactory Analgesia with Less Intraoperative Hypotension for Spinal Anesthesia in Cesarean Section</title><pmid><json:string>22533726</json:string></pmid><genre><json:string>article</json:string></genre><host><title>CNS Neuroscience & Therapeutics</title><language><json:string>unknown</json:string></language><doi><json:string>10.1111/(ISSN)1755-5949</json:string></doi><issn><json:string>1755-5930</json:string></issn><eissn><json:string>1755-5949</json:string></eissn><publisherId><json:string>CNS</json:string></publisherId><volume>18</volume><issue>5</issue><pages><first>426</first><last>432</last><total>7</total></pages><genre><json:string>journal</json:string></genre><subject><json:item><value>META‐ANALYSIS</value></json:item></subject></host><namedEntities><unitex><date><json:string>2012</json:string></date><geogName></geogName><orgName><json:string>Department of Anesthesiology, Shanghai</json:string><json:string>People’s Hospital, Tongji University</json:string><json:string>Department of Anaesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Keywords Bupivacaine</json:string><json:string>Nanjing Medical University</json:string><json:string>People’s Hospital, Tongji University School of Medicine, Shanghai, China</json:string><json:string>Blackwell Publishing Ltd</json:string></orgName><orgName_funder></orgName_funder><orgName_provider></orgName_provider><persName><json:string>Qing Lin</json:string><json:string>College</json:string><json:string>Li-Ming Zhang</json:string><json:string>Hui-Hua Li</json:string></persName><placeName><json:string>China</json:string></placeName><ref_url></ref_url><ref_bibl><json:string>[11,13,14,18]</json:string><json:string>[1,11,20]</json:string><json:string>[23]</json:string><json:string>[2,6]</json:string><json:string>[11,14,16]</json:string><json:string>[18]</json:string><json:string>[22]</json:string><json:string>[10]</json:string><json:string>Chung et al. 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[14]</json:string><json:string>[11,13,16,18]</json:string><json:string>[24]</json:string><json:string>[4,5]</json:string></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/WNG-LQX6MFGH-7</json:string></ark><categories><wos><json:string>1 - science</json:string><json:string>2 - pharmacology & pharmacy</json:string><json:string>2 - neurosciences</json:string></wos><scienceMetrix></scienceMetrix><scopus><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - Pharmacology (medical)</json:string><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - Physiology (medical)</json:string><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - Psychiatry and Mental health</json:string><json:string>1 - Life Sciences</json:string><json:string>2 - Pharmacology, Toxicology and Pharmaceutics</json:string><json:string>3 - Pharmacology</json:string></scopus></categories><publicationDate>2012</publicationDate><copyrightDate>2012</copyrightDate><doi><json:string>10.1111/j.1755-5949.2012.00306.x</json:string></doi><id>1E06A598D21218A1EA9ABF0C627AAD543CBA2295</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/1E06A598D21218A1EA9ABF0C627AAD543CBA2295/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/1E06A598D21218A1EA9ABF0C627AAD543CBA2295/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/1E06A598D21218A1EA9ABF0C627AAD543CBA2295/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main">Combination of Low‐Dose Bupivacaine and Opioids Provides Satisfactory Analgesia with Less Intraoperative Hypotension for Spinal Anesthesia in Cesarean Section</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><availability><licence>© 2012 Blackwell Publishing Ltd</licence></availability><date type="published" when="2012-05"></date></publicationStmt><notesStmt><note type="content-type" subtype="article" source="article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-6N5SZHKN-D">article</note><note type="publication-type" subtype="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note></notesStmt><sourceDesc><biblStruct type="article"><analytic><title level="a" type="main">Combination of Low‐Dose Bupivacaine and Opioids Provides Satisfactory Analgesia with Less Intraoperative Hypotension for Spinal Anesthesia in Cesarean Section</title><title level="a" type="short">A Meta‐Analysis of 11 Trials</title><author xml:id="author-0000"><persName><forename type="first">Man‐Tang</forename><surname>Qiu</surname></persName><affiliation>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China<address><country key="CN"></country></address></affiliation><affiliation>First Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China<address><country key="CN"></country></address></affiliation><note type="foot">Both authors contributed equally to this work.</note></author><author xml:id="author-0001"><persName><forename type="first">Fu‐Qing</forename><surname>Lin</surname></persName><affiliation>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China<address><country key="CN"></country></address></affiliation><note type="foot">Both authors contributed equally to this work.</note></author><author xml:id="author-0002"><persName><forename type="first">Shu‐Kun</forename><surname>Fu</surname></persName><affiliation>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China<address><country key="CN"></country></address></affiliation></author><author xml:id="author-0003"><persName><forename type="first">Heng‐Bin</forename><surname>Zhang</surname></persName><affiliation>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China<address><country key="CN"></country></address></affiliation><affiliation>First Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China<address><country key="CN"></country></address></affiliation></author><author xml:id="author-0004"><persName><forename type="first">Hui‐Hua</forename><surname>Li</surname></persName><affiliation>Department of Anaesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA<address><country key="US"></country></address></affiliation></author><author xml:id="author-0005"><persName><forename type="first">Li‐Ming</forename><surname>Zhang</surname></persName><affiliation>Department of Anaesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA<address><country key="US"></country></address></affiliation></author><author xml:id="author-0006"><persName><forename type="first">Quan</forename><surname>Li</surname></persName><affiliation>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China<address><country key="CN"></country></address></affiliation></author><idno type="istex">1E06A598D21218A1EA9ABF0C627AAD543CBA2295</idno><idno type="ark">ark:/67375/WNG-LQX6MFGH-7</idno><idno type="DOI">10.1111/j.1755-5949.2012.00306.x</idno><idno type="unit">CNS306</idno><idno type="toTypesetVersion">file:CNS.CNS306.pdf</idno></analytic><monogr><title level="j" type="main">CNS Neuroscience & Therapeutics</title><title level="j" type="alt">CNS NEUROSCIENCE THERAPEUTICS</title><idno type="pISSN">1755-5930</idno><idno type="eISSN">1755-5949</idno><idno type="book-DOI">10.1111/(ISSN)1755-5949</idno><idno type="book-part-DOI">10.1111/cns.2012.18.issue-5</idno><idno type="product">CNS</idno><idno type="publisherDivision">ST</idno><imprint><biblScope unit="vol">18</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="426">426</biblScope><biblScope unit="page" to="432">432</biblScope><biblScope unit="page-count">7</biblScope><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2012-05"></date></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><abstract xml:lang="en" style="main"><p><hi rend="bold">SUMMARY </hi>
<hi rend="bold">Aims:</hi> This meta‐analysis was undertaken to compare the three most common drug regimens of bupivacaine in spinal anesthesia for cesarean section: high‐dose bupivacaine (≥10 mg, HB), low‐dose bupivacaine (<10 mg, LB) and combination of low‐dose bupivacaine and opioids (LBO). <hi rend="bold">Methods:</hi> Databases of MEDLINE, EMBASE, and Cochrane Library were searched (updated on October 30, 2011). Primary endpoints were the incidence of intraoperative hypotension and analgesia efficacy. Pooled risk ratio (RR) or standard mean difference and their 95% confidence intervals (95% CI) were calculated. A RR <1 indicates that LB or LBO regimen is associated with less intraoperative complications and better anesthesia or analgesia efficacy. <hi rend="bold">Results:</hi> A total of 11 randomized controlled trials including 605 parturients were analyzed. Results of this meta‐analysis showed that compared with HB regimen, LB regimen decreased the incidence of intraoperative hypotension (RR = 0.64, 95% CI: 0.42–0.96) with less satisfactory analgesia (fixed model, RR = 1.50, 95% CI: 1.14–1.98). LBO regimen significantly reduced the incidence of intraoperative hypotension (RR = 0.52, 95% CI: 0.33–0.82) with reliable analgesia efficacy (RR = 2.56, 95% CI: 0.77–8.48). <hi rend="bold">Conclusion:</hi> Compared with conventional HB regimen and LB regimen, LBO regimen not only reduced intraoperative hypotension but also provided reliable analgesia. Therefore, LBO regimen should be considered as the preferred drug combination for spinal anesthesia in cesarean section.</p></abstract><textClass><keywords xml:lang="en"><term xml:id="k1">Bupivacaine</term><term xml:id="k2">Cesarean section</term><term xml:id="k3">Hypotension</term><term xml:id="k4">Opioids</term><term xml:id="k5">Spinal anesthesia</term></keywords><keywords rend="tocHeading1"><term>Meta‐Analysis</term></keywords><keywords rend="articleCategory"><term>META‐ANALYSIS</term></keywords></textClass><langUsage><language ident="en"></language></langUsage></profileDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/1E06A598D21218A1EA9ABF0C627AAD543CBA2295/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Publishing Ltd</publisherName><publisherLoc>Oxford, UK</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1755-5949</doi><issn type="print">1755-5930</issn><issn type="electronic">1755-5949</issn><idGroup><id type="product" value="CNS"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="CNS NEUROSCIENCE THERAPEUTICS">CNS Neuroscience & Therapeutics</title></titleGroup></publicationMeta><publicationMeta level="part" position="05105"><doi origin="wiley">10.1111/cns.2012.18.issue-5</doi><numberingGroup><numbering type="journalVolume" number="18">18</numbering><numbering type="journalIssue" number="5">5</numbering></numberingGroup><coverDate startDate="2012-05">May 2012</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="11" status="forIssue"><doi origin="wiley">10.1111/j.1755-5949.2012.00306.x</doi><idGroup><id type="unit" value="CNS306"></id></idGroup><countGroup><count type="pageTotal" number="7"></count></countGroup><titleGroup><title type="tocHeading1">Meta‐Analysis</title><title type="articleCategory">META‐ANALYSIS</title></titleGroup><copyright>© 2012 Blackwell Publishing Ltd</copyright><eventGroup><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:3.1.3 standalone mode:FullText" date="2012-05-02"></event><event type="publishedOnlineFinalForm" date="2012-04-25"></event><event type="firstOnline" date="2012-04-25"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-01-15"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.3.7 mode:FullText" date="2015-03-24"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="426">426</numbering><numbering type="pageLast" number="432">432</numbering></numberingGroup><correspondenceTo>Quan Li, Ph.D., M.D., Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University, 301 Yanchang Middle Rd, Shanghai 200072, China.
Tel.: 86‐21‐66307531;
Fax: 86‐21‐66307531;
E‐mail: <email>quanligene@126.com</email></correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:CNS.CNS306.pdf"></link></linkGroup></publicationMeta><contentMeta><unparsedEditorialHistory>Received 9 December 2011; revision 1 January 2012; accepted 5 January 2012</unparsedEditorialHistory><countGroup><count type="figureTotal" number="6"></count><count type="tableTotal" number="2"></count><count type="formulaTotal" number="0"></count><count type="referenceTotal" number="27"></count><count type="linksCrossRef" number="61"></count></countGroup><titleGroup><title type="main">Combination of Low‐Dose Bupivacaine and Opioids Provides Satisfactory Analgesia with Less Intraoperative Hypotension for Spinal Anesthesia in Cesarean Section</title><title type="shortAuthors">M.‐T. Qiu <i>et al</i>.</title><title type="short">A Meta‐Analysis of 11 Trials</title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#a1 #a2" noteRef="#fn1"><personName><givenNames>Man‐Tang</givenNames><familyName>Qiu</familyName></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#a1" noteRef="#fn1"><personName><givenNames>Fu‐Qing</givenNames><familyName>Lin</familyName></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#a1"><personName><givenNames>Shu‐Kun</givenNames><familyName>Fu</familyName></personName></creator><creator creatorRole="author" xml:id="cr4" affiliationRef="#a1 #a2"><personName><givenNames>Heng‐Bin</givenNames><familyName>Zhang</familyName></personName></creator><creator creatorRole="author" xml:id="cr5" affiliationRef="#a3"><personName><givenNames>Hui‐Hua</givenNames><familyName>Li</familyName></personName></creator><creator creatorRole="author" xml:id="cr6" affiliationRef="#a3"><personName><givenNames>Li‐Ming</givenNames><familyName>Zhang</familyName></personName></creator><creator creatorRole="author" xml:id="cr7" affiliationRef="#a1"><personName><givenNames>Quan</givenNames><familyName>Li</familyName></personName></creator></creators><affiliationGroup><affiliation xml:id="a1" countryCode="CN"><unparsedAffiliation>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China</unparsedAffiliation></affiliation><affiliation xml:id="a2" countryCode="CN"><unparsedAffiliation>First Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China</unparsedAffiliation></affiliation><affiliation xml:id="a3" countryCode="US"><unparsedAffiliation>Department of Anaesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en"><keyword xml:id="k1">Bupivacaine</keyword><keyword xml:id="k2">Cesarean section</keyword><keyword xml:id="k3">Hypotension</keyword><keyword xml:id="k4">Opioids</keyword><keyword xml:id="k5">Spinal anesthesia</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><p><b>SUMMARY </b> <b>Aims:</b> This meta‐analysis was undertaken to compare the three most common drug regimens of bupivacaine in spinal anesthesia for cesarean section: high‐dose bupivacaine (≥10 mg, HB), low‐dose bupivacaine (<10 mg, LB) and combination of low‐dose bupivacaine and opioids (LBO). <b>Methods:</b> Databases of MEDLINE, EMBASE, and Cochrane Library were searched (updated on October 30, 2011). Primary endpoints were the incidence of intraoperative hypotension and analgesia efficacy. Pooled risk ratio (RR) or standard mean difference and their 95% confidence intervals (95% CI) were calculated. A RR <1 indicates that LB or LBO regimen is associated with less intraoperative complications and better anesthesia or analgesia efficacy. <b>Results:</b> A total of 11 randomized controlled trials including 605 parturients were analyzed. Results of this meta‐analysis showed that compared with HB regimen, LB regimen decreased the incidence of intraoperative hypotension (RR = 0.64, 95% CI: 0.42–0.96) with less satisfactory analgesia (fixed model, RR = 1.50, 95% CI: 1.14–1.98). LBO regimen significantly reduced the incidence of intraoperative hypotension (RR = 0.52, 95% CI: 0.33–0.82) with reliable analgesia efficacy (RR = 2.56, 95% CI: 0.77–8.48). <b>Conclusion:</b> Compared with conventional HB regimen and LB regimen, LBO regimen not only reduced intraoperative hypotension but also provided reliable analgesia. Therefore, LBO regimen should be considered as the preferred drug combination for spinal anesthesia in cesarean section.</p></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn1"><p>Both authors contributed equally to this work.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Combination of Low‐Dose Bupivacaine and Opioids Provides Satisfactory Analgesia with Less Intraoperative Hypotension for Spinal Anesthesia in Cesarean Section</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>A Meta‐Analysis of 11 Trials</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Combination of Low‐Dose Bupivacaine and Opioids Provides Satisfactory Analgesia with Less Intraoperative Hypotension for Spinal Anesthesia in Cesarean Section</title></titleInfo><name type="personal"><namePart type="given">Man‐Tang</namePart><namePart type="family">Qiu</namePart><affiliation>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China</affiliation><affiliation>First Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China</affiliation><description>Both authors contributed equally to this work.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Fu‐Qing</namePart><namePart type="family">Lin</namePart><affiliation>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China</affiliation><description>Both authors contributed equally to this work.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Shu‐Kun</namePart><namePart type="family">Fu</namePart><affiliation>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Heng‐Bin</namePart><namePart type="family">Zhang</namePart><affiliation>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China</affiliation><affiliation>First Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Hui‐Hua</namePart><namePart type="family">Li</namePart><affiliation>Department of Anaesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Li‐Ming</namePart><namePart type="family">Zhang</namePart><affiliation>Department of Anaesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Quan</namePart><namePart type="family">Li</namePart><affiliation>Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-6N5SZHKN-D">article</genre><originInfo><publisher>Blackwell Publishing Ltd</publisher><place><placeTerm type="text">Oxford, UK</placeTerm></place><dateIssued encoding="w3cdtf">2012-05</dateIssued><edition>Received 9 December 2011; revision 1 January 2012; accepted 5 January 2012</edition><copyrightDate encoding="w3cdtf">2012</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><extent unit="figures">6</extent><extent unit="tables">2</extent><extent unit="formulas">0</extent><extent unit="references">27</extent><extent unit="linksCrossRef">61</extent></physicalDescription><abstract>SUMMARY Aims: This meta‐analysis was undertaken to compare the three most common drug regimens of bupivacaine in spinal anesthesia for cesarean section: high‐dose bupivacaine (≥10 mg, HB), low‐dose bupivacaine (<10 mg, LB) and combination of low‐dose bupivacaine and opioids (LBO). Methods: Databases of MEDLINE, EMBASE, and Cochrane Library were searched (updated on October 30, 2011). Primary endpoints were the incidence of intraoperative hypotension and analgesia efficacy. Pooled risk ratio (RR) or standard mean difference and their 95% confidence intervals (95% CI) were calculated. A RR <1 indicates that LB or LBO regimen is associated with less intraoperative complications and better anesthesia or analgesia efficacy. Results: A total of 11 randomized controlled trials including 605 parturients were analyzed. Results of this meta‐analysis showed that compared with HB regimen, LB regimen decreased the incidence of intraoperative hypotension (RR = 0.64, 95% CI: 0.42–0.96) with less satisfactory analgesia (fixed model, RR = 1.50, 95% CI: 1.14–1.98). LBO regimen significantly reduced the incidence of intraoperative hypotension (RR = 0.52, 95% CI: 0.33–0.82) with reliable analgesia efficacy (RR = 2.56, 95% CI: 0.77–8.48). Conclusion: Compared with conventional HB regimen and LB regimen, LBO regimen not only reduced intraoperative hypotension but also provided reliable analgesia. Therefore, LBO regimen should be considered as the preferred drug combination for spinal anesthesia in cesarean section.</abstract><subject lang="en"><genre>keywords</genre><topic>Bupivacaine</topic><topic>Cesarean section</topic><topic>Hypotension</topic><topic>Opioids</topic><topic>Spinal anesthesia</topic></subject><relatedItem type="host"><titleInfo><title>CNS Neuroscience & Therapeutics</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><subject><genre>article-category</genre><topic>META‐ANALYSIS</topic></subject><identifier type="ISSN">1755-5930</identifier><identifier type="eISSN">1755-5949</identifier><identifier type="DOI">10.1111/(ISSN)1755-5949</identifier><identifier type="PublisherID">CNS</identifier><part><date>2012</date><detail type="volume"><caption>vol.</caption><number>18</number></detail><detail type="issue"><caption>no.</caption><number>5</number></detail><extent unit="pages"><start>426</start><end>432</end><total>7</total></extent></part></relatedItem><identifier type="istex">1E06A598D21218A1EA9ABF0C627AAD543CBA2295</identifier><identifier type="ark">ark:/67375/WNG-LQX6MFGH-7</identifier><identifier type="DOI">10.1111/j.1755-5949.2012.00306.x</identifier><identifier type="ArticleID">CNS306</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2012 Blackwell Publishing Ltd</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-L0C46X92-X">wiley</recordContentSource><recordOrigin>Blackwell Publishing Ltd</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/document/1E06A598D21218A1EA9ABF0C627AAD543CBA2295/metadata/json</uri></json:item></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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