Efficacy and safety of intrathecal adjuvants for perioperative management of cesarean delivery: a systematic review and network meta-analysis of randomized controlled trials
Authors' conclusion
While the strength of evidence, overall, was very low to low, our study suggests that while none of the interventions significantly reduced pain intensity at 24 hours, several significantly prolonged effective analgesia and reduced postoperative opioid consumption.
Study context
- Population
- Women undergoing cesarean section (CS) under single-shot spinal anaesthesia
- Participants
- 14,925 women · 166 randomized controlled trials (RCTs)
- Comparison
- Intrathecal adjuvants or placebo added to long-acting local anaesthetic
Pooled result
As reported in the abstract
- Pain intensity at 24 hours: buprenorphine and diamorphine highest-ranked, though not statistically significant
- Morphine alone or with meperidine, neostigmine, epinephrine or nalbuphine significantly increased duration of effective analgesia and reduced opioid consumption
- Dexmedetomidine and morphine significantly prolonged motor block duration
- Strength of evidence very low to low
Safety
- Safety profile generally adequate; none significantly increased severe adverse events
Original publication
Efficacy and safety of intrathecal adjuvants for perioperative management of cesarean delivery: a systematic review and network meta-analysis of randomized controlled trials. Reg Anesth Pain Med. Published 26 March 2025. doi:10.
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