口服修改释放的风险和益处与手术后口服即时释放阿片类药物的使用相比:系统性审查和元分析
1Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, NSW, Australia.
Anaesthesia
|July 7, 2023
概括
与立即释放版本相比,用于术后疼痛的修改释放阿片类药物会增加不良事件并加重疼痛. 证据表明,在有效性方面没有优越性,可能会导致更高的持续性阿片类药物使用.
科学领域:
- 药理学 药理学 是一个学科.
- 疼痛管理 疼痛管理
- 临床研究 临床研究
背景情况:
- 改性释放 (MR) 类阿片类药物通常用于治疗急性术后疼痛.
- 有关它们的安全性和增加不良影响的可能性存在担忧.
- 对手术后疼痛的MR与即时释放 (IR) 口服阿片类药物进行比较的证据有限.
研究的目的:
- 系统地审查和分析关于MR与IR口服阿片类药物的安全性和有效性的证据,用于成人术后疼痛.
- 为了比较不良事件的发生率,疼痛强度,止痛药的使用和身体功能.
主要方法:
- 随机临床试验和观察性研究的系统审查和元分析.
- 从2003年1月到2023年1月,搜索了五个电子数据库.
- 包括对成人手术患者口服MR阿片类与口服IR阿片类进行比较的研究.
主要成果:
- 来自八项纳入研究的证据总体质量较低 (5项RCT,3项观察性).
- 与IR相比,MR阿片类药物的使用与更高的不良事件 (OR 2.76) 和更糟糕的疼痛 (SMD 0.2) 相关.
- 在止痛药消费,住院,再入院或身体功能方面,MR与IR没有优势.
结论:
- 修改释放的口服阿片类药物对于术后疼痛管理的立即释放配方没有任何优势.
- 使用MR阿片类药物与不良事件的增加以及潜在的持续术后阿片类药物使用率的增加有关.
- 需要进一步研究心理功能,成本和生活质量等长期结果.
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