手术后阿片类药物与无阿片类药物止痛:随机试验的系统审查和元分析
Julio F Fiore1, Charbel El-Kefraoui2, Marc-Aurele Chay3
1Department of Surgery, McGill University, Montreal, QC, Canada; Division of Experimental Surgery, McGill University, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
在手术后处方阿片类药物不会减轻疼痛,但会增加吐等不良事件. 无阿片类药物治疗是轻微和中度手术的可行选择.
科学领域:
- 治疗疼痛
- 药理学
- 手术的结果
背景情况:
- 在手术后过度处方阿片类药物有助于阿片类危机.
- 对疼痛和不良事件的阿片类药物处方的有效性是不确定的.
研究的目的:
- 为了比较阿片类药物和无阿片类药物在手术释放时的止痛药.
- 评估对疼痛强度和不良事件的影响.
主要方法:
- 随机对照试验 (RCT) 的系统审查和元分析至2021年7月.
- 包括15岁以上接受轻微至重大复杂手术的患者.
- 使用GRADE确定性评估疼痛强度,吐和其他不良事件.
主要成果:
- 处方阿片类药物没有降低出院后的疼痛强度 (中度确定性).
- 使用阿片类药物显著增加吐风险 (高确定性) 和其他不良事件.
- 对其他评估结果没有显著影响.
结论:
- 处方阿片类药物不会减轻疼痛,而是增加不良事件.
- 在轻微/中度选择性手术中可以考虑无阿片类药物止痛.
- 需要进一步进行高质量的研究,特别是在重大程序中.
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