The Associations Between CYP2D6*10 C188T Polymorphism and Pharmacokinetics and Clinical Outcomes of Tramadol: A Systematic Review and Meta-analysis

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3679-3690 ◽  
Author(s):  
Qing-Hua Wen ◽  
Zheng Zhang ◽  
Wen-Ke Cai ◽  
Xiao-Qian Lin ◽  
Gong-Hao He
Keyword(s):  
Clinical Outcomes ◽  
Meta Analysis ◽  
Postoperative Nausea And Vomiting ◽  
Opioid Analgesics ◽  
Visual Analog Scale Score ◽  
Nausea And Vomiting ◽  
Cochrane Library ◽  
Pharmacokinetic Parameters ◽  
Total Consumption ◽  
The Cochrane Library

Abstract Background Tramadol is one of the most extensively used centrally acting synthetic opioid analgesics. Recently, a number of studies have explored the associations of the CYP2D6*10 C188T polymorphism with pharmacokinetic and clinical outcomes of tramadol. However, the results of these previous reports remain controversial. Therefore, a meta-analysis was needed to reach a consensus. Methods PubMed, EMBASE, and the Cochrane Library were searched to identify eligible studies that explored the influence of the CYP2D6*10 C188T polymorphism on clinical outcomes of tramadol through April 2019. Articles meeting the inclusion criteria were comprehensively reviewed by two independent evaluators. A meta-analysis was performed using Review Manager 5.3. Results A total of nine studies involving 809 related subjects were included in this meta-analysis. Significant associations were found between CYP2D6*10 C188T mutation and longer serum tramadol half-lives, larger AUC0-∞, and the slower clearance rate of tramadol. In addition, we also found that CYP2D6*10 C188T had effects on the pharmacokinetic parameters of the metabolite of tramadol, O-desmethyltramadol, by sensitive analysis. Furthermore, CYP2D6*10 C188T polymorphism was associated with higher visual analog scale score, loading dose, and total consumption of tramadol. There was no significant association between CYP2D6*10 C188T polymorphism and postoperative nausea and vomiting. Conclusions CYP2D6*10 C188T polymorphism had a significant influence on tramadol pharmacokinetics and analgesic effect, but there was insufficient evidence to demonstrate that this polymorphism was associated with incidence of nausea and vomiting.

scholarly journals Granisetron plus dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery: A meta-analysis

2017 ◽  
Vol 45 (3) ◽  
pp. 904-911 ◽  
Author(s):  
Min Zhu ◽  
Chengmao Zhou ◽  
Bing Huang ◽  
Lin Ruan ◽  
Rui Liang
Keyword(s):  
Laparoscopic Surgery ◽  
Postoperative Nausea ◽  
Adverse Reactions ◽  
Meta Analysis ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Cochrane Library ◽  
Randomized Controlled ◽  
Laparoscopy Surgery ◽  
The Cochrane Library

Objective This study was designed to compare the effectiveness of granisetron plus dexamethasone for preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic surgery. Methods We searched the literature in the Cochrane Library, PubMed, EMBASE, and CNKI. Results In total, 11 randomized controlled trials were enrolled in this analysis. The meta-analysis showed that granisetron in combination with dexamethasone was significantly more effective than granisetron alone in preventing PONV in patients undergoing laparoscopy surgery. No significant differences in adverse reactions (dizziness and headache) were found in association with dexamethasone. Conclusion Granisetron in combination with dexamethasone was significantly more effective than granisetron alone in preventing PONV in patients undergoing laparoscopic surgery, with no difference in adverse reactions between the two groups. Granisetron alone or granisetron plus dexamethasone can be used to prevent PONV in patients undergoing laparoscopic surgery.

scholarly journals Effects of palonosetron and ondansetron on preventing nausea and vomiting after laparoscopic surgery

2017 ◽  
Vol 46 (1) ◽  
pp. 411-420 ◽  
Author(s):  
Qili Liu ◽  
Chengmao Zhou ◽  
Zeqing Bao ◽  
Yu Zhu
Keyword(s):  
Laparoscopic Surgery ◽  
Meta Analysis ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Cochrane Library ◽  
Time Intervals ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled ◽  
Significant Difference ◽  
The Cochrane Library

Background This meta-analysis was performed to evaluate the efficacy and safety of palonosetron and ondansetron in preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic surgery with general anesthesia. Methods We searched for randomized controlled clinical trials in PubMed, Embase, and The Cochrane Library. Results Nine studies were enrolled in this meta-analysis and showed no statistically significant difference between palonosetron and ondansetron in the prevention of PONV in the first 24 hours after surgery (relative risk [RR], 0.62; 95% confidence interval [CI], 0.35–1.10). Palonosetron more effectively prevented vomiting at various time intervals during the first 24 hours postoperatively than did ondansetron: 0–2 hours (RR, 0.45; 95% CI, 0.26–0.78), 2–6 hours (RR, 0.74; 95% CI, 0.39–1.40), and 6–24 hours (RR, 1.20; 95% CI, 0.55–2.64). No significant differences in side effects were found between palonosetron and ondansetron (RR, 0.67; 95% CI, 0.40–1.14). Conclusion This meta-analysis demonstrated that palonosetron is not more efficacious than ondansetron in the prevention of early PONV. However, palonosetron was more efficacious than ondansetron in the prevention of vomiting after laparoscopic surgery.

scholarly journals Intravenous dexmedetomidine during spinal anaesthesia for caesarean section: A meta-analysis of randomized trials

2017 ◽  
Vol 45 (3) ◽  
pp. 924-932 ◽  
Author(s):  
Zeqing Bao ◽  
Chengmao Zhou ◽  
Xianxue Wang ◽  
Yu Zhu
Keyword(s):  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Relevant Literature ◽  
Nausea And Vomiting ◽  
Cochrane Library ◽  
Control Group ◽  
Efficacy And Safety ◽  
The Cochrane Library

Objective To evaluate the efficacy and safety of spinal anaesthesia using dexmedetomidine for caesarean section. Methods PubMed, The Cochrane Library, and CNKI were searched for relevant literature. Results The incidence of nausea and vomiting in the dexmedetomidine group was significantly lower than that in the control group (OR = 0.21, 95% CI: 0.12–0.35, P < 0.00001). No difference was found in the incidence of pruritus between the two groups (OR = 1.21, 95% CI: 0.36–4.09, P = 0.76).The dexmedetomidine group had a higher incidence of bradycardia than did the control group (OR = 2.20, 95% CI: 1.02–4.77, P = 0.05). The incidence of shivering in the dexmedetomidine group was significantly lower than that in the control group (OR = 0.20, 95% CI: 0.13–0.32, P < 0.00001). The incidence of hypotension was not different between the two groups (OR = 0.88, 95% CI: 0.49–1.56, P = 0.65). Conclusion Dexmedetomidine can decrease the incidence of nausea, vomiting, bradycardia, and shivering with spinal anaesthesia during caesarean section.

Outcomes of digital biomarker-based interventions: protocol for a systematic review of systematic reviews (Preprint)

2021 ◽  
Author(s):  
Hossein Motahari-Nezhad ◽  
Márta Péntek ◽  
László Gulácsi ◽  
Zsombor Zrubka
Keyword(s):  
Clinical Outcomes ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Clinical Benefits ◽  
The Cochrane Library ◽  
The Impact ◽  
Digital Biomarkers

BACKGROUND Digital biomarkers are defined as objective, quantifiable physiological and behavioral data that are collected and measured by means of digital devices such as portables, wearables, implantables or digestibles. For their widespread adoption in publicly financed healthcare systems, it is important to understand how their benefits translate into improved patient outcomes, which is essential for demonstrating their value. OBJECTIVE To assess the quality and strength of evidence of the impact of digital biomarkers on clinical outcomes compared to interventions without digital biomarkers, reported in systematic reviews. METHODS A comprehensive search for 2019-2020 will be conducted in the PubMed and the Cochrane Library using keywords related to digital biomarkers and a filter for systematic reviews. Original full-text English publications of systematic reviews comparing clinical outcomes of interventions with and without digital biomarkers via meta-analysis will be included. The AMSTAR-2 tool will be used to assess the methodological quality of reviews. To assess the quality of evidence, we will evaluate systematic reviews using the GRADE tool. To detect the possible presence of reporting bias, we will record whether the protocol of the systematic reviews was published before the start of the study. A qualitative summary of results by digital biomarker technology and outcome will be provided. RESULTS This protocol was submitted before data collection. The next steps in this review will be initiated after the protocol is accepted for publication. CONCLUSIONS Our study will provide a comprehensive summary of the highest level of evidence available on digital biomarker interventions. Our results will help identify clinical areas where the use of digital biomarkers leads to favorable clinical outcomes. In addition, our findings will highlight areas of evidence gaps where the clinical benefits of digital biomarkers have not yet been demonstrated.

The serratus plane block for postoperative analgesia in breast and thoracic surgery: a systematic review and meta-analysis

2019 ◽  
pp. rapm-2019-100982 ◽  
Author(s):  
Matthew Chong ◽  
Nicolas Berbenetz ◽  
Kamal Kumar ◽  
Cheng Lin
Keyword(s):  
Thoracic Surgery ◽  
Postoperative Analgesia ◽  
Meta Analysis ◽  
Analgesic Efficacy ◽  
Postoperative Nausea And Vomiting ◽  
Cochrane Library ◽  
Assessment Development ◽  
Pain Scores ◽  
Language Restriction ◽  
The Cochrane Library

Background and objectivesThe serratus plane block (SPB) is a novel chest wall interfascial plane block. Its analgesic efficacy compared with non-block care and paravertebral block (PVB) is unestablished.MethodsWe conducted a random-effects meta-analysis of randomized controlled trials (RCTs) recruiting adult surgical patients that compared a SPB to non-block care or PVB for postoperative analgesia. Visual analog scale pain scores were the primary outcome. Database sources were Medline, Embase, the Cochrane Library, and Google Scholar searched up to July 29, 2019 without language restriction. Risk of bias was assessed using Cochrane methodology.ResultsNineteen RCTs that comprised 1260 patients were included. Six trials involved thoracic surgery patients and 13 studied breast surgery patients. SPB reduced pain scores 0 hour postoperatively (−1.62 cm; 99% CI −2.43 to −0.81; p<0.001; I2=92%), at 2–4 hours (−1.29 cm; 99% CI −2.08 to −0.49; p<0.001; I2=92%), at 6 hours (−1.69 cm; 99% CI −3.19 to −0.20; p=0.004; I2=99%), and up to 24 hours compared with non-block care. SPB also prolonged the time to first analgesic request (193.2 min; 95% CI 7.2 to 379.2 min; p=0.04; I2=99%), reduced 24-hour postoperative opioid consumption (−11.27 mg of IV morphine equivalent; −17.36 to −5.18 mg; p<0.001), and reduced postoperative nausea and vomiting (RR 0.51; 95% CI 0.38 to 0.68; p<0.001; I2=12%). In contrast, no meaningful differences were detected in any of the outcomes for the SPB versus PVB data.ConclusionsSPB reduced postoperative pain scores (Grading of Recommendations Assessment, Development, and Evaluation rating: low; due to heterogeneity and deficiencies in blinding) in breast and thoracic surgery patients compared with non-block care. Based on five trials only, SPB was not appreciably different from PVB.

scholarly journals Comparison of ramosetron and ondansetron for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery: a meta-analysis of randomized controlled trials

2019 ◽  
Vol 47 (10) ◽  
pp. 4591-4603 ◽  
Author(s):  
Yiping Li ◽  
Ruiming Deng ◽  
Juan Zhou ◽  
Yuan Chen ◽  
Aiping Ouyang
Keyword(s):  
Laparoscopic Surgery ◽  
Randomized Controlled Trials ◽  
Postoperative Nausea ◽  
Meta Analysis ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Postoperative Treatment ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled

Objective We conducted a systematic literature search and meta-analysis to identify randomized controlled trials (RCTs) comparing the efficacy and safety of ramosetron versus ondansetron for the prevention of postoperative nausea and vomiting (PONV; PON and POV, respectively) in patients undergoing laparoscopic surgery. Methods The electronic databases PubMed, EMBASE, Web of Science, and Cochrane Library were searched up to March 2019 to identify relevant studies. Results The final pooled analysis included 6 RCTs and revealed that postoperative treatment with ramosetron at 24 to 48 hours after surgery significantly reduced the incidence of PON and POV relative to treatment with ondansetron. In a subgroup analysis, ramosetron 0.3 mg tended to reduce PON (0–2 hours) and POV (24–48 hours) more effectively than ondansetron 4 mg. However, no statistical difference was observed between ramosetron 0.3 mg and ondansetron 8 mg in terms of the reduction of PON or POV during any time interval within the first 48 hours after surgery. Conclusions Our results indicate that ramosetron 0.3 mg is superior to ondansetron 4 mg and comparable to ondansetron 8 mg for PONV prophylaxis after laparoscopic surgery.

scholarly journals Pregabalin does not decrease acute pain or postoperative nausea and vomiting after hysterectomy: a meta-analysis

2020 ◽  
Vol 48 (12) ◽  
pp. 030006052095472
Author(s):  
Jie Ni ◽  
Juan Jiang ◽  
Shiqin Mao ◽  
Rui-fang Sun
Keyword(s):  
Postoperative Nausea ◽  
Web Of Science ◽  
Meta Analysis ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Cochrane Library ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Severe Postoperative Pain ◽  
Visual Disturbances

Objective Hysterectomy is associated with severe postoperative pain. The relative efficacy of pregabalin compared with other treatments for post-hysterectomy pain is unclear. Methods We searched the PubMed, Cochrane Library, and Web of Science databases for studies that compared the use of pregabalin and placebo for reducing pain in patients undergoing hysterectomy. Results This meta-analysis showed that pregabalin had limited pain-relieving effects at 2, 6, 24, and 48 hours after hysterectomy compared with placebo. Pregabalin significantly reduced postoperative nausea and vomiting. However, there was no significant difference in postoperative sedation or visual disturbances between patients treated with pregabalin and placebo. Conclusions Pregabalin is not clinically superior to placebo in terms of reducing pain intensity and morphine consumption in patients undergoing hysterectomy. However, the limitations of this meta-analysis mean that more high-quality randomized controlled trials are necessary to verify our pooled results.

scholarly journals Dexamethasone for the prevention of postoperative nausea and vomiting in children undergoing non-cardiac surgery: a systematic review and meta-analysis

2019 ◽  
Author(s):  
Qihong Shen ◽  
Hui-fang Li ◽  
Xu-yan Zhou ◽  
Xiao-zong Yuan
Keyword(s):  
Cardiac Surgery ◽  
Randomized Controlled Trials ◽  
Postoperative Nausea ◽  
Meta Analysis ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Effective Measure ◽  
Randomized Controlled

Abstract BACKGROUND: Postoperative nausea and vomiting (PONV) is a frequent and distressing complication of general anaesthesia in paediatric patients. Dexamethasone was reported to prevent PONV in previous randomized controlled trials (RCTs). The purpose of this meta-analysis was to evaluate the role of dexamethasone in the prevention of PONV in children undergoing non-cardiac surgery. METHODS: PubMed, EMBASE, the Cochrane Library, and Web of Science were searched to identify randomized trials that reported the efficacy of perioperative dexamethasone in paediatric non-cardiac surgical patients. RESULTS: Fourteen randomized controlled trials that included 1700 children were included. Compared with placebo, dexamethasone showed a lower incidence of PONV by intravenous injection (RR 0.38, 95% confidence interval (CI) 0.30–0.49) and by local infiltration (RR 0.58, 95% CI 0.34–0.99). The combination of dexamethasone and a 5-HT3 receptor antagonist was more effective than the 5-HT3 antagonist or dexamethasone alone in preventing PONV. CONCLUSION: Perioperative dexamethasone was an effective measure with few complications for preventing PONV in children after non-cardiac surgery.

scholarly journals 5HT3 Antagonists versus Dexamethasone in the Prevention of PONV in Patients Undergoing Laparoscopic Cholecystectomy: A Meta-Analysis of RCTs

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Chengmao Zhou ◽  
Yu Zhu ◽  
Zhen Liu ◽  
Lin Ruan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Meta Analysis ◽  
Postoperative Nausea And Vomiting ◽  
Early Postoperative Period ◽  
Cochrane Library ◽  
Significant Heterogeneity ◽  
Randomized Controlled ◽  
Significant Difference ◽  
5Ht3 Antagonists ◽  
The Cochrane Library

Background. 5HT3 antagonist, an antiemetic alternative to dexamethasone, is an effective drug for the prevention of postoperative nausea and vomiting (PONV). Methods. PubMed and The Cochrane Library (from inception to June 2016) were searched for relevant RCTs (randomized controlled trials). Results. Seven trials, totaling 682 patients, were included in this meta-analysis. This meta-analysis demonstrated that 5HT3 antagonist was as effective as dexamethasone in preventing PONV (RR, 1.12; 95% CI, [0.86, 1.45]; P=0.40) within 24 hours of laparoscopic cholecystectomy, and no significant heterogeneity was observed among the studies (I2=0%; P=0.98). During the early postoperative period (0–6 h), 5HT3 antagonists were superior to dexamethasone in reducing POV (RR, 0.31; 95% CI, [0.11, 0.93]; P=0.04), while, in other postoperative stages (6–12 h, 12–24 h, and 0–24 h), it was not more effective in the prevention of POV than dexamethasone. And no significant difference was found in the prevention of PON between 5HT3 antagonists and dexamethasone at different postoperative periods (0–6 h, 6–12 h, 12–24 h, and 0–24 h). Conclusions. As a result, it is advisable to encourage 5HT3 antagonists as an alternative to dexamethasone for the prevention of PONV in patients undergoing laparoscopic cholecystectomy.

The Associations Between CYP2D6 Metabolizer Status and Pharmacokinetics and Clinical Outcomes of Venlafaxine: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 52 (05) ◽  
pp. 222-231 ◽  
Author(s):  
Xiao-Qian Lin ◽  
Ping Wang ◽  
Wen-Ke Cai ◽  
Gui-Li Xu ◽  
Mei Yang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Clinical Outcomes ◽  
Rating Scale ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Pharmacokinetic Parameters ◽  
Therapeutic Effects ◽  
Knowledge Infrastructure ◽  
The Relationship

Abstract Background The association between CYP2D6 metabolizer status and clinical outcomes of venlafaxine was extensively investigated previously, but no widely accepted conclusion has been reached so far. To obtain a more precise estimation of the association, a systematic review by meta-analysis was conducted in the present study. Methods The PubMed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure, Technology of Chongqing, and Wan Fang Database were searched for eligible studies up to August 2018. Results Fourteen related studies involving 1035 patients were finally included. Significant associations were found among 3 CYP2D6 phenotypes (NM, IM, and PM) and most pharmacokinetic parameters of venlafaxine. However, CYP2D6 phenotypes were not associated with Hamilton Depression Rating Scale response of venlafaxine. In addition, we also found no significant association between CYP2D6 phenotype and overall rate of adverse events. Conclusions CYP2D6 metabolizer status had significant influence on venlafaxine pharmacokinetics, but insufficient evidence demonstrated that CYP2D6 metabolizer status was associated with its therapeutic effects and overall rate of adverse events, which provided further evidence regarding the relationship between CYP2D6 metabolizer status and venlafaxine.

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