Dezocine may actively suppress opioid-induced cough; BMJ

In a new study conducted by Li-Xian He and team it was found that opioid-induced cough (OIC) was greatly suppressed by dezocine (DZC), which might be utilized to treat it. More high-quality RCTs are required to supplement DZC's safety. The findings of this study were published in the British Medical Journal on 4th April, 2022.

Coughing is common when administering an opioid bolus. The mechanism of opioid-induced cough is complicated and unknown, however it may involve lung chemoreflex, increased parasympathetic nerve activity, histamine release, opioid receptor dualism, and muscle stiffness. As a result, the purpose of this study was to perform a systematic evaluation of the effects of dezocine on the frequency and severity of opioid-induced cough.

PubMed, Cochrane Library, Embase, Ovid, Web of Science, as well as Chinese Bio Medical Literature & Retrieval System, China National Knowledge Infrastructure, Wanfang, and VIP were used for this systematic review and meta-analysis. The data was searched from 1978 to the 31st of December, 2020. All RCTs comparing DZC to placebo in terms of the incidence rate and severity of OIC were examined. RevMan V.5.3 was used to analyze all of the data. Each outcome was assessed for heterogeneity, and in the presence or absence of significant heterogeneity, a randomized-effects or fixed-effects model was adopted.

The key findings of this study were as follow:

1. This search returned 33 RCTs with a total of 4442 patients, with 2521 assigned to the DZC group and 1921 to the control group.

2. During the induction of general anesthesia, 1880 patients received fentanyl and 2562 received sufentanil.

3. DZC considerably decreased the incidence rate of OIC caused by either fentanyl or sufentanil, according to the meta-analysis.

4. The meta-analysis also revealed that the occurrence of mild, moderate, and severe OIC was significantly lower in the DZC group than in the control group.

5. Furthermore, except for dizziness, the current meta-analysis found that DZC pretreatment was not related with a higher incidence rate of side effects.

In conclusion, this meta-analysis found that DZC greatly suppressed OIC and might be utilized to treat OIC caused by fentanyl or sufentanil. More high-quality RCTs are required to supplement DZC's safety.

Reference: He L, Yao Y, Shao K, et al, Efficacy of dezocine on preventing opioid-induced cough during general anaesthesia induction: a PRISMA-compliant systematic review and meta-analysis, BMJ Open 2022;12:e052142. doi:10.1136/bmjopen-2021-052142

Keywords: General anesthesia, dizzy, fentanyl, coughing, opioid bolus, dezocine, parasympathetic, muscle stiffness, lung, reflex, British Medical Journal,