術後のエピデュラル鎮痛の有効性:メタ解析
Brian M Block1, Spencer S Liu, Andrew J Rowlingson
1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Md 21287, USA.
JAMA
|November 13, 2003
まとめ
エピデュラル鎮痛は,親腸内オピオイドと比較して,より優れた術後の痛みのコントロールを提供します. このシステマティック・レビューは,様々な手術や痛みの評価において,その有効性を確認し,手術後の不快感の管理のための好ましい方法として確立しました.
科学分野:
- 麻酔学と疼痛管理について
- 根拠に基づいた医学は,証拠に基づいた医療です.
- 手術ケアについてです.
背景:
- 術後の疼痛管理は,患者の回復の重要な側面であり続けています.
- 術後の痛みに対する外周麻酔鎮痛と親腸内オピオイドの比較効果は議論されている.
- 最適な疼痛管理戦略を特定することは,手術結果を改善するために不可欠です.
研究 の 目的:
- 術後の痛みを和らげるための親腸内オピオイドに対する外周麻酔の有効性を体系的にレビューし,比較する.
- これらの2つの鎮痛技法を評価したランダム化対照試験の証拠を合成する.
- 術後の鎮痛のための好ましい方法に関する明確な勧告を提供すること.
主な方法:
- 1966年から2002年4月まで,PubMedやその他のデータベースの体系的な文献検索.
- 成人患者におけるペデュラル療法と親経オピオイドを比較したランダム化比較試験の含有.
- 視覚アナログまたは数値評価スケールを用いた痛みの評価;固定効果モデルを使用してデータ抽出と分析.
主要な成果:
- 視線アナログスケール (VAS) (19.40 mm vs 29.40 mm; P<.001) で,エピデュラル鎮痛は親腸内オピオイドよりも痛みのコントロールが有意に優れていることが示されました.
- エピデュラル療法による上位鎮痛は,すべての術後日およびほとんどの手術タイプで一貫していました.
- 吐き気,嘔吐,およびかゆみの合併症率は予想より低く,モーターブロックは既存のデータと比較できます.
結論:
- エピデュラル鎮痛は,鎮痛剤,カテーテル部位,または疼痛評価方法に関係なく,親腸内オピオイドよりも,術後の疼痛管理のより効果的な方法です.
- この発見は,外科手術後の痛みをコントロールするために,外周麻酔のルーチン使用を裏付けている.
- 更に研究が進められれば,特定の患者集団や外周麻酔が最大の効果をもたらす外科的なコンテキストを調査することが可能になる.
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