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Intravenous oxytocin regimens in patients undergoing cesarean delivery: a systematic review and network meta-analysis of cluster-based groups

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Abstract

Information on evaluations of different oxytocin regimens used to prevent post-partum hemorrhage during cesarean delivery is scarce, and there is a lack of statistically pooled results for comparative doses. In this review, we aimed to analyze the effectiveness of different oxytocin regimens used and rank them accordingly. We performed a meta-analysis of randomized controlled trials (RCTs) reporting the incidence of additional uterotonic (AUT) use or amount of blood loss during cesarean delivery, where different oxytocin regimens were compared. Cluster analysis was used to define different clusters of oxytocin therapy based on the identified variable regimens. During the frequentist network meta-analysis, all clusters were compared to bolus clusters of dose range 3–5 IU. Data from 33 RCTs (6741 patients) to 26 RCTs (5422 patients) were assessed for AUT use and blood loss, respectively. Pairwise meta-analysis revealed a significant reduction in the use of AUTs or blood loss was recorded for bolus–infusion combination regimens. The network meta-analysis found that combined bolus–infusion regimens of (i) 3–5 IU and 0.25–1 IU/min or (ii) 3–5 IU and < 0.25 IU/min had statistically significant results for lowest consumption of AUTs (Ranks 1 and 2, respectively); whereas with the latter’s use, the lowest blood loss (Rank 2) was observed. In contrast, the dose range, > 5 IU regimen was associated with higher side effects (lowest rank). During cesarean delivery, a significant reduction in the use of AUTs or blood loss (Rank 2) was recorded for bolus–infusion combination regimens. High doses did not have enough evidence to draw meaningful conclusions.

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Acknowledgements

We sincerely acknowledge Dr Rajani Kadri, M.S., Associate Professor, Department of Opthalmology, A J I M S and Research Centre, Mangalore for her excellent support, contribution and cooperation during the preparation of manuscript. We also thank Mr. Arun Rao, B.E., and Mr. Yaganand, B.E, Data Scientists, for their kind help during manuscript preparation.

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Authors and Affiliations

  1. Department of Anaesthesiology, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, 575004, India

    Thrivikrama Padur Tantry, Harish Karanth & Pramal K. Shetty

  2. Department of Obstetrics and Gynecology, King Khalid University College of Medicine, Abha, Saudi Arabia

    Saravana Anniyappa

  3. Department of Anaesthesiology, Kasturba Medical College, MAHE, Mangalore, 575001, India

    Madhusudan Upadya

  4. Department of Urology and Transplant Surgery, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, 575004, India

    Sunil P. Shenoy

  5. Department of Plastic and Reconstructive Surgery, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, 575004, India

    Dinesh Kadam

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  1. Thrivikrama Padur Tantry
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Tantry, T.P., Karanth, H., Anniyappa, S. et al. Intravenous oxytocin regimens in patients undergoing cesarean delivery: a systematic review and network meta-analysis of cluster-based groups. J Anesth 37, 278–293 (2023). https://doi.org/10.1007/s00540-022-03132-w

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