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5-HT3 Receptor Antagonists for Propofol Injection Pain: A Meta-Analysis of Randomized Controlled Trials

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Abstract

Background and Objectives

5-hydroxytryptamine3 (5-HT3) receptor antagonists have been commonly used to reduce propofol injection pain. The aim of this meta-analysis was to evaluate the efficacy and safety of 5-HT3 receptor antagonists in decreasing the incidence and intensity of propofol injection pain.

Methods

Online databases of Pubmed, Embase and the Cochrane Central Register of Controlled Trials were searched as well as reference lists of included studies and recent reviews. Eligible randomized controlled trials (RCTs) assessing the efficacy and safety of 5-HT3 receptor antagonists for propofol injection pain were identified. The outcomes included the incidence and intensity of propofol injection pain and adverse effects. We calculated risk ratios (RR) with 95 % confidence intervals (CIs) for dichotomous data and adopted fixed or random-effects model when proper.

Results

A total of eight RCTs were included in the final analysis. Compared with the control group, 5-HT3 receptor antagonists were related to a decreasing incidence of propofol injection pain (RR 0.43, 95 % CI 0.33–0.56, P < 0.05). Besides, they also effectively alleviated the severity of propofol injection pain. They significantly reduced the number of patients with moderate (RR 0.21, 95 % CI 0.15–0.30, P < 0.05) and severe pain (RR 0.16, 95 % CI 0.10–0.25, P < 0.05) during propofol injection. 5-HT3 receptor antagonists and lidocaine were equally effective in preventing propofol injection pain. Moreover, only one article mentioned the adverse effects of 5-HT3 receptor antagonists in two patients.

Conclusion

Our meta-analysis indicates that 5-HT3 receptor antagonists can effectively reduce the incidence and severity of propofol injection pain. Additionally, 5-HT3 receptor antagonists may become the alternatives to lidocaine in attenuating propofol injection pain. However, evidence is still limited for the safety of 5-HT3 receptor antagonists on propofol injection pain.

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Author notes

    Authors and Affiliations

    1. Department of Anesthesiology, Cancer Institute and Hospital, National Cancer Center, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 17 Panjiayuannanli, Chaoyang District, Beijing, 100021, China

      Wen Wang, Liang Zhou, Lin-Xin Wu, Chao-Bing Zhang & Li Sun

    2. Institute for Hospital Management, Tsinghua University, Haidian District, Beijing, 100084, China

      Tong Wang

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    1. Wen Wang
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    2. Liang Zhou
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    Correspondence to Li Sun.

    Additional information

    W. Wang and L. Zhou contribute equally to this article and should be considered co-first authors.

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    Wang, W., Zhou, L., Wu, LX. et al. 5-HT3 Receptor Antagonists for Propofol Injection Pain: A Meta-Analysis of Randomized Controlled Trials. Clin Drug Investig 36, 243–253 (2016). https://doi.org/10.1007/s40261-016-0375-1

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