截肢后疼痛:随机对照试验的综合分析,评估阿片类药物和 gabapentinoids 与安慰剂
Adam Arthur1,2, Leonardo Kapural3, Richard P Chiacchierini4
1Department of Neurological Surgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN, USA.
Journal of pain research
|October 29, 2024
概括
近50%的截肢者经历了长期的术后阿片类药物使用. 这项研究比较了吗啡和 gabapentin 对截肢后的疼痛,发现两者都是有效的,但强调了需要长期研究.
科学领域:
- 疼痛管理 疼痛管理
- 药理学 药理学是指药理学的学科.
- 外科手术的结果
背景情况:
- 截肢截肢每年影响美国约185,000名患者.
- 近50%的截肢者经历了长期的术后阿片类药物使用 (90-180天).
- 手术前使用类药物,肌肉松剂,抗药和抗抑郁药与长时间使用阿片类药物有关,这表明需要新的策略.
研究的目的:
- 评估在治疗截肢后疼痛方面选择的药理学药物的疗效.
- 评估截肢者现有的疼痛管理策略的成功率.
主要方法:
- 选PubMed随机对照试验 (RCT) 涉及 gabapentinoids (gabapentin,pregabalin) 或阿片类药物 (吗啡).
- 从质量上比较了两个吗啡RCT和两个 gabapentin试验与安慰剂.
- 在4至6周的急性期内分析了截肢后的疼痛.
主要成果:
- 吗啡比安慰剂 (P=0.02) 具有统计学显著的治疗效果,治疗所需数量 (NNT) 为3.9.
- 加巴丁也显示出比安慰剂显著的效果,估计NNT为8.9.
- 这两种药物都在4至6周的急性截肢后期进行了评估.
结论:
- 经历肢体截肢的患者对有效的慢性疼痛控制有重大未满足的需求.
- 该研究强调需要进行更大规模,更长期的受控试验,以评估截肢者慢性加巴类药物和阿片类药物的使用情况.
- 进一步的研究至关重要,以了解这些药物的长期益处和风险,以管理慢性截肢后疼痛.
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