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Sufentanil versus fentanyl for pain relief in labor involving combined spinal-epidural analgesia: a systematic review and meta-analysis of randomized controlled trials

  • Clinical Trial
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European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

To systematically compare the efficacy and safety of sufentanil versus fentanyl for pain relief in labor involving combined spinal-epidural analgesia (CSEA), a systematic review and meta-analysis of randomized controlled trials targeting parturients requesting labor analgesia was conducted.

Methods

The primary outcome measure was visual analog scale scores assessed at 10, 15, 30, and 60 min after intrathecal injection. Secondary outcomes included duration of spinal analgesia, incidence of side effects in parturients, and neonatal Apgar scores.

Results

Twelve randomized controlled trials, including data from 881 patients fulfilled the inclusion criteria. No clinically meaningful differences in pain reduction after intrathecal injection were found between the two analgesics. Sufentanil extended the duration of spinal analgesia by 25.40 min (95% CI 21.82 to 28.98 min; p < 0.00001) compared with fentanyl. The risk for pruritus, nausea, and vomiting among parturients was 82% for those using sufentanil (relative risk 0.82 [95% CI 0.67–0.99]; p = 0.04) and 48% for those using fentanyl (relative risk 0.48 [95% CI 0.29–0.80]; p = 0.005). Both the synthesis results and sensitivity analysis demonstrated no differences in the risk for respiratory depression between parturients using sufentanil versus fentanyl. The neonates in sufentanil group exhibited higher Apgar scores than the fentanyl group 5 min after delivery (weighted mean difference 0.10 [95% CI 0.05–0.16]; p = 0.0002).

Conclusion

Existing evidence suggests that compared with fentanyl, sufentanil used for analgesia in combined spinal-epidural during labor is more effective in extending the duration of spinal analgesia, and may be safer for the infant. There was overall low clinical and statistical heterogeneity among the included studies. For all outcomes, variations caused by heterogeneity across trials were acceptable. Thus the findings of this meta-analysis may provide additional evidence for future clinical practices of pain relief in labor involving CSEA. Stronger evidence supporting this conclusion will require data from more high-quality and multicenter randomized controlled trials.

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Acknowledgements

The authors appreciate the advice provided by Professor Yuguang Huang and his team at Peking Union Medical College Hospital, and funding provided by the Peking Union Medical College Education Fund 2017-2019.

Funding

This study was supported by the Peking Union Medical College Education Fund 2017–2019.

Author information

Authors and Affiliations

  1. School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China

    Mengjia Zhi, Yifan Diao, Shiyang Liu, Zhiran Huang, Xiawen Su, Jing Sun & Yuanli Liu

  2. Beijing 306 Hospital, Beijing, 100101, People’s Republic of China

    Shuai Geng

  3. Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China

    Le Shen

Authors
  1. Mengjia Zhi
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  2. Yifan Diao
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  4. Zhiran Huang
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  8. Jing Sun
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Contributions

The study was designed by the team led by SJ and LY. Authors worked in pairs for all reviews and analysis. LS and GS, and HZ and SX independently screened all retrieved trials by reviewing their titles and abstracts. ZM and DY, LS and GS, and HZ and SX independently evaluated the full-text literature for eligibility using the standardized criteria, and extracted relevant data from the full texts using a standardized data collection form, including key information regarding the trials, results of primary and secondary outcome measures, anesthetic dosage and usage, and parturient obstetric characteristics and their baseline comparability. Any disagreement between authors was resolved jointly by SJ, SL and LY. All authors agree with the submitted manuscript.

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Correspondence to Jing Sun.

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Zhi, M., Diao, Y., Liu, S. et al. Sufentanil versus fentanyl for pain relief in labor involving combined spinal-epidural analgesia: a systematic review and meta-analysis of randomized controlled trials. Eur J Clin Pharmacol 76, 501–506 (2020). https://doi.org/10.1007/s00228-019-02806-x

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