神经轴性水利摩尔的有效性和安全性:系统性审查和元分析,并进行试验顺序分析
Sina Grape1, Kariem El-Boghdadly2, Cécile Jaques3
1Department of Anesthesia, Valais Hospital, Sion, Switzerland; University of Lausanne, Lausanne, Switzerland.
Journal of clinical anesthesia
|October 23, 2024
概括
神经轴液态摩尔在手术后提供最小的疼痛缓解,很少有证据支持其使用. 虽然它可能会增加,但需要进一步的试验来确定最佳剂量和副作用.
科学领域:
- 麻醉学 麻醉学
- 药理学 药理学是指药理学的学科.
- 疼痛管理 疼痛管理
背景情况:
- 神经轴液态摩尔用于术后疼痛缓解.
- 精确的疗效和最佳剂量仍然不清楚.
研究的目的:
- 系统地审查和分析关于神经轴摩尔治疗术后疼痛的证据.
- 为了确定缓解疼痛的程度,并确定最佳的剂量策略.
主要方法:
- 六项涉及436名患者的试验的系统审查和元分析.
- 使用试验顺序分析来评估证据的确定性.
- 主要结局:24小时休息时的疼痛评分;次要结局:其他时间的疼痛评分,恶心,吐和.
主要成果:
- 在24小时内,神经轴液态显示出具有统计学意义的,但在临床上无意义的静止疼痛减少 (平均差异: -0.4).
- 没有观察到术后恶心和吐的显著增加.
- 观察到的显著增加 (风险比:3.1).
- 对所有结果的总体证据质量非常低.
结论:
- 目前的证据表明,神经轴液态摩素在手术后提供了最小的疼痛缓解,并增加了的风险.
- 减少疼痛的临床意义是可疑的.
- 更多高质量的试验至关重要,以便在广泛使用之前确定最佳剂量和充分描述副作用.
相关概念视频
Opioid Analgesics: Synthetic and Semisynthetic Opioids
234
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
234
Local Anesthetics: Clinical Application as Epidural Anesthesia
414
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
414
Analgesia and Pain Management
534
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
534
Local Anesthetics: Clinical Application as Spinal Anesthesia
585
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
585
Local Anesthetics: Adverse Effects
392
While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
392
Opioid Analgesics: Morphine and Other Natural Cogeners
187
Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
187


