机器人手术中的内吗啡和术后疼痛缓解:系统性审查和元分析
Zi Heng Tee1, Erica Ho Ching Tsoi1, Quinston Lee1
1School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK.
Journal of clinical medicine
|January 11, 2024
概括
在机器人辅助手术 (RAS) 后,内吗啡 (ITM) 显著减少了疼痛和阿片类药物的使用. 然而,这种疼痛管理策略也增加了不良事件的发生率,需要仔细考虑.
科学领域:
- 麻醉学和疼痛管理
- 手术创新 在外科创新.
- 基于证据的医学基于证据的医学.
背景情况:
- 内吗啡 (ITM) 对手术后疼痛控制有潜在的益处.
- 在机器人辅助手术 (RAS) 中ITM的具体作用和最佳剂量仍然不够明确.
- 需要评估现实世界的证据,以评估RAS患者的ITM疗效和结果.
研究的目的:
- 在接受机器人辅助手术 (RAS) 的患者中,系统地审查和评估内吗啡 (ITM) 的疗效和结果.
- 评估ITM对休息时的疼痛评分和在术后24小时和48小时的运动的影响.
- 在RAS的背景下,探索与ITM使用相关的不良事件的发生率.
主要方法:
- 这是一个按照PRISMA指导方针进行的系统审查,搜索了MEDLINE,Embase,Cochrane图书馆和APA PsycInfo.
- 包括9项随机对照试验 (RCT),涉及619名患者,其中298人接受ITM.
- 进行的元分析以确定疼痛得分和阿片类药物消费的平均差异,并使用Cochrane风险偏差2工具进行偏差风险评估.
主要成果:
- 在手术后24小时内,在ITM组中观察到休息时 (MD = -27.15) 和运动时 (MD = -25.88) 的疼痛得分显著降低.
- 在24小时后,手术后静脉注射吗啡等效消耗显著下降 (MD = -20.13) 与ITM有关.
- ITM在24小时和48小时改善了疼痛评分,但与不良事件发生率的增加有关.
结论:
- 在机器人辅助手术中,静脉内吗啡在减少术后疼痛和阿片类药物需求方面表现出显著的有效性.
- 在疼痛管理中,ITM的好处必须与增加不良事件风险相对衡量.
- 可能需要进一步的研究来优化ITM剂量和减轻RAS的副作用.
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