术后外围止痛疗法的有效性:一个元分析
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
概括
外周止痛疗法提供优越的术后疼痛控制与亲肠道阿片类药物相比. 这一系统性审查证实了其在各种手术和疼痛评估中的有效性,并将其确立为管理手术后不适的首选方法.
科学领域:
- 麻醉学和疼痛管理
- 基于证据的医学基于证据的医学.
- 手术护理 手术护理
背景情况:
- 术后疼痛管理仍然是患者康复的关键方面.
- 外围止痛疗法与管类阿片类药物对术后疼痛的比较疗效仍在争论中.
- 确定最佳的疼痛控制策略对于改善外科手术结果至关重要.
研究的目的:
- 系统地审查和比较外围止痛药与内阿片类药物对术后疼痛缓解的有效性.
- 综合了评估这两种止痛技术的随机对照试验的证据.
- 提供关于术后止痛的首选方法的明确建议.
主要方法:
- 从1966年到2002年4月,对PubMed和其他数据库进行系统的文献搜索.
- 包括随机对照试验,比较成人患者的外周治疗与腹腔内阿片类药物.
- 使用视觉模拟或数值评分尺度进行疼痛评估;使用固定效应模型进行数据提取和分析.
主要成果:
- 在视觉模拟尺度 (VAS) 上,外周止痛疗法表现出明显更好的疼痛控制,而不是亲肠类阿片类药物 (19.40 mm vs 29.40 mm; P<.001).
- 使用外围注射方法的高级镇痛在所有术后的日子和大多数手术类型中都是一致的.
- 恶心,吐和的并发症率低于预期,运动阻塞与现有数据相比.
结论:
- 外围注射止痛是一种更有效的术后疼痛管理方法,而不是亲肠道阿片类药物,无论是止痛剂,导管部位或疼痛评估方法.
- 这些发现支持在手术后常规使用外周止痛疗法来控制手术后的疼痛.
- 进一步的研究可能会探索特定的患者群体或外科手术背景,其中外周止痛提供了最大的好处.
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