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Meta-Analysis
. 2023 Sep 22;102(38):e35021.
doi: 10.1097/MD.0000000000035021.

Effect of ondansetron compared to lidocaine and placebo for reducing propofol injection pain: A systematic review and meta-analysis of randomized controlled trials

Mohamed Sayed Zaazouee  1 , Abdelrahman Mohamed Mahmoud  2 , Waleed Hosny Elfar  3 , Kerolous Hana  4 , Kerollos F Shamshoon  4 , Michael H Adly  4 , Tarek A Hussein  4 , Mohammad M Hamza  5 , Abrar Abdelhamid Aly  6 , Mohammed Ahmed Eguzo  6 , Abdullah Mohamed Farhat  7 , Ahmed Bostamy Elsnhory  3 , Mohammed Hassan Morsy  6 , Manar Farag Ammar  8 , Abdalrhman Abdalmajid Alnaji  9 , Alaa Ahmed Elshanbary  6 , Jaffer Shah  10 , Yossef Hassan AbdelQadir  6
Affiliations
Meta-Analysis

Effect of ondansetron compared to lidocaine and placebo for reducing propofol injection pain: A systematic review and meta-analysis of randomized controlled trials

Mohamed Sayed Zaazouee et al. Medicine (Baltimore). .

Abstract

Objective: Propofol is the most commonly used intravenous anesthetic medication and is most commonly associated with post-operative pain. Several drugs are investigated to reduce post-operative pain caused by propofol injection. Ondansetron is a potent anti-emetic drug showing promising results as an analgesic. This meta-analysis aims to compare the efficacy of ondansetron to placebo and lidocaine in reducing post-operative pain caused by propofol injection.

Methods: PubMed, Embase, Cochrane Library, Web of Science, and Scopus were searched for relevant randomized controlled trials (RCTs) till May 2022. We conducted a meta-analysis using RevMan software version 5.4, and we assessed the quality of included RCTs using the Cochrane risk of bias tool.

Results: In our study, we included 23 RCTs with 2957 participants. Compared to placebo, ondansetron significantly increased the rate of no pain [risk ratio (RR) = 2.36, 95% confidence interval (CI) (1.39-4.01)], and reduced moderate [RR = 0.39, 95% CI (0.30-0.52)] and severe pain [RR = 0.34, 95% CI (0.24-0.50)]. Furthermore, ondansetron significantly reduced PONV [RR = 0.73, 95% CI (0.58, 0.91)]. On the other hand, ondansetron showed an inferior efficacy to lidocaine regarding the incidence of no, moderate, and severe pain.

Conclusion: Ondansetron is effective in reducing post-operative propofol-induced pain. However, lidocaine is more effective than it.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
PRISMA flow chart. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
Figure 2.
Figure 2.
Risk of bias summary.
Figure 3.
Figure 3.
A forest plot of no propofol injection pain incidence in the ondansetron group compared with the placebo group.
Figure 4.
Figure 4.
A forest plot of mild propofol injection pain incidence in the ondansetron group compared with the placebo group. (A) Before sensitivity analysis and (B) after sensitivity analysis.
Figure 5.
Figure 5.
A forest plot of moderate propofol injection pain incidence in the ondansetron group compared with the placebo group.
Figure 6.
Figure 6.
A forest plot of severe propofol injection pain incidence in the ondansetron group compared with the placebo group.
Figure 7.
Figure 7.
A forest plot of post-operative nausea and vomiting incidence in the ondansetron group compared with the placebo group.
See this image and copyright information in PMC

References

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