Combined low dose local anesthetics and opioids versus single use of LA for transurethral urological surgery: A meta‑analysis

Abstract

Introduction: The combination of reduced dose of local anesthetics (LA) and highly lipid‑soluble synthetic opioids for patients undergoing transurethral surgery could reduce block duration and side‑effects. However, it remains unclear what are the most appropriate levels of low dose and the extent to which the side‑effects could be controlled. A meta‑analysis was conducted to address this concern.
Materials and Methods: Based on twelve randomized controlled trials, this meta‑analysis pooled previous results to generate integrated evidence.
Results: Combined low dose of LA and opioids had similar sensory block and significantly shorter motor block duration (weighted mean difference: –39.31 min, 95% confidence interval (CI): –50.58–−28.05, P < 0.00001) compared with single use of LA. There was no evidence of higher risk of analgesic failure in the combination group. In addition, combined low dose LA and opioids was associated with significantly reduced rate of postoperative hypotension (risk ratios (RR): 0.60, 95% CI: 0.37–0.96, P = 0.03) and shivering (RR: 0.27, 95% CI: 0.11–0.64, P = 0.003), but with higher rate of sedation (RR: 3.14, 95% CI: 1.02–9.66, P = 0.05).
Conclusion: Combined low dose LA and opioids is a better choice for patients received transurethral surgery compared with single use of intrathecal LA.

Key words: Intrathecal anesthesia, local anesthetics, opioids, transurethral surgery