The Effects of Low-dose Naloxone in Intravenous Fentanyl Patient-Controlled Analgesia

Low‐Dose Naloxone for Prophylaxis of Postoperative Nausea and Vomiting: A Systematic Review and Meta‐analysis

“…However, tramadol and fentanyl may require differing naloxone dosing thresholds for reducing adverse effects than morphine. In our review, naloxone did not demonstrate reduction in PONV in patients receiving fentanyl, although an inherently low‐risk patient population (overall PONV < 23%) and PCA delivery may have contributed to this study outcome.…”

“…Another two studies found no changes in opioid needs among patients receiving naloxone for PONV; however, graphic‐only rendering of data did not allow pooled analysis of opioid consumption. Administration of naloxone for PONV had no overall effect on postoperative VAS pain scores compared with control (mean difference −0.11, 95% CI −0.26 to 0.05, p=0.18) when assessed by six studies (Figure ). Only two of these trials reported concurrent opioid consumption to evaluate the context of pain scores, making it possible to examine the effect of low‐dose naloxone on opioid analgesia …”

“…Three of nine studies recorded postoperative antiemetic medication doses and found statistically significant decreases among patients receiving naloxone (RR 0.64 #bib95% CI 0.42–0.96, p=0.03; Figure ) . However, reduction in antiemetic dosing needs and PONV among patients receiving naloxone should be interpreted with caution based on limited patient documentation (n=186) relative to the total patient pool (n=946).…”

“…Calculation and retention of the necessary sample size to detect naloxone effects on PONV was available in five of the nine trials . However, the remaining four studies would have likely displayed adequate sample size, as each reported a patient census that exceeded enrollment in trials powered to detect prophylaxis of PONV. Four of the nine trials did not blind patients to treatment assignments.…”

“…However, pharmacokinetic dissimilarities between epidural and intravenous administration of naloxone and opioids excluded these trials from collective data analysis. Finally, whereas seven of the nine studies administered morphine for analgesia, two studies used tramadol or fentanyl in managing postsurgical pain . Although postoperative opioid use is a validated risk for PONV, no difference exists among opioids in promoting PONV .…”