Opioids With or Without Low-Dose Naloxone During the Perioperative Period: A Systematic Review With Meta-Analysis.

Objectives

The aim of this systematic review and meta-analysis from randomized controlled trials is to assess opioids with or without low-dose naloxone during the perioperative period at pain intensity and opioids-related adverse events.

Methods

We searched of Medline, Embase, International Clinical Trials Registry Platform, and the Cochrane Library up to May 31, 2023. We included randomized controlled trials (RCTs) of low-dose naloxone combined with opioids in adults reporting pain intensity or opioid-related adverse event during the perioperative period.

Results

A total of 18 RCTs with 1784 participants were included. We could not reach a consistent conclusion for pain intensity due to high heterogeneity. High certainty evidence showed that low-dose naloxone combined with opioids reduced the risk of nausea (relative risk (RR): 0.82 and 95% confidence interval (CI): 0.70-0.96), cough (RR: 0.52 and 95% CI: 0.30-0.90) and postoperative nausea and vomiting (RR: 0.58 and 95% CI: 0.40-0.80). Moderate certainty evidence showed that low-dose naloxone combined with opioids did not reduce vomiting, urinary retention, sedation, dizziness, respiratory depression, headache, drowsiness, shivering, skin itch, hypotension, and sweating.

Conclusions

Our findings show that the use of low-dose naloxone in combination with opioids can lower the risk of somnolence and coughing, postoperative nausea, and vomiting.