The effect of Neurokinin-1 receptor antagonists on postoperative pain: A meta-analysis of randomized controlled trials

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-02-08 DOI:10.1016/j.jclinane.2025.111772

Filippo D'Amico MD , Eoin Kelleher MD , Jacopo D'Andria Ursoleo MD , Andrey G. Yavorovskiy MD , Stefano Turi MD , Sara Zaffaroni MD , Viviana Teresa Agosta MD , Silvia Ajello MD , Giovanni Landoni MD

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引用次数: 0

Abstract

Study objective

Substance P is a neuropeptide with a pivotal role in pain transmission and modulation. Preclinical studies suggest that targeting substance P and inhibiting its receptor, neurokinin 1 (NK−1), is a potential avenue for pain relief. When translated into clinical settings, these preliminary findings yielded mixed results. This meta-analysis of randomized controlled trials (RCTs) aims to investigate whether a preemptive administration of NK-1 antagonists may reduce postoperative pain.

Design

We searched PubMed, Cochrane and EMBASE from inception to January 3, 2025, for studies comparing NK-1 antagonists versus placebo or standard care that reported data on postoperative pain. The primary outcome was pain at two hours after surgery measured through a 0–10 numeric scale. Secondary outcomes were postoperative pain at 24 and at 48 h and postoperative morphine equivalent consumption.

Setting

Hospitals.

Main results

The search strategies identified 13 RCTs with a total of 1959 patients. All studies reported a single preoperative administration of NK-1 antagonists. NK-1 antagonists reduced postoperative pain two hours (n = 8; MD -0.62; 95 % CI: −0.91, −0.32; P < 0.001; I2 = 0 %) and at 24 h (n = 9; MD -0.65; 95 % CI: −1.22, −0.09; P = 0.02; I2 = 86 %) but not 48 h after surgery. Morphine equivalent consumption was similar in the two groups.

Conclusions

Preoperative single-administration of NK-1 antagonists reduces postoperative pain. The observed pain reduction pattern is consistent with the pharmacokinetics (half-life 9–12 h) of these inhibitors and with data from preclinical studies.

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神经激肽-1受体拮抗剂对术后疼痛的影响：随机对照试验的荟萃分析

研究目的P物质是一种在疼痛传递和调节中起关键作用的神经肽。临床前研究表明，靶向P物质并抑制其受体神经激肽1 （NK - 1）是缓解疼痛的潜在途径。当转化到临床环境时，这些初步发现产生了不同的结果。这项随机对照试验（RCTs）的荟萃分析旨在研究先发制人给予NK-1拮抗剂是否可以减轻术后疼痛。设计：我们检索PubMed、Cochrane和EMBASE数据库，从建立到2025年1月3日，比较NK-1拮拮剂与安慰剂或标准治疗的研究报告了术后疼痛的数据。主要结果是术后两小时的疼痛，通过0-10的数字量表测量。次要结局是术后24小时和48小时的疼痛以及术后吗啡当量的消耗。背景医院。主要结果检索策略确定了13项随机对照试验，共纳入1959例患者。所有的研究都报道了单次术前给药NK-1拮抗剂。NK-1拮抗剂减少术后2小时疼痛(n = 8；MD -0.62;95% ci:−0.91,−0.32；P & lt;0.001;I2 = 0 %)和24h (n = 9；MD -0.65;95% ci:−1.22,−0.09；p = 0.02；I2 = 86%)，但术后48 h无明显差异。两组的吗啡当量消耗量相似。结论术后单次给予NK-1拮抗剂可减轻术后疼痛。观察到的疼痛减轻模式与这些抑制剂的药代动力学（半衰期9-12小时）和临床前研究的数据一致。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.