与基于阿片类药物的麻醉相比,无阿片类麻醉的有效性和安全性:系统性审查和网络元分析
Vincenzo Francesco Tripodi1, Salvatore Sardo2, Mariachiara Ippolito3,4
1Anesthesia and Intensive Care, Human Pathology Department, University Hospital "Gaetano Martino", Via Consolare Valeria 1, Messina, 98124, Italy.
Journal of anesthesia, analgesia and critical care
|August 14, 2025
概括
没有阿片类药物的麻醉 (OFA) 似乎不比基于阿片类药物的麻醉 (OBA) 更有效,在24小时内减少手术后的疼痛. 需要进一步的研究来澄清OFA疗程的疗效和安全性.
科学领域:
- 麻醉学 麻醉学
- 疼痛管理 疼痛管理
- 基于证据的医学基于证据的医学.
背景情况:
- 无阿片类药物麻醉 (OFA) 是一种新兴的麻醉管理方法,旨在改善术后结果.
- 对OFA与基于阿片类药物的麻醉 (OBA) 的比较疗效和安全性仍然不确定.
- 这项研究旨在将不同的OFA疗法与OBA进行比较.
研究的目的:
- 系统地比较各种无阿片类麻醉 (OFA) 方案与阿片类麻醉 (OBA) 方案的有效性和安全性.
- 评估手术后24小时疼痛强度作为首要结果指标.
主要方法:
- 一个系统的审查和frequentist随机效应网络对42个随机对照试验 (RCTs) 的元分析,涉及4666名患者.
- 使用数值评分表 (NRS),视觉模拟表 (VAS) 或口头评分表 (VRS) 评估的疼痛强度.
- 用于评估证据确定性的GRADE方法.
主要成果:
- 网络元分析显示,在OBA和各种OFA疗法之间,24小时后疼痛强度没有显著差异.
- 对主要结果的证据确定性在所有比较中从中等到非常低.
- 在包括的研究中,OFA疗程的显著异质性和高偏差风险 (>70%) 被注意到.
结论:
- 没有任何特定的OFA疗法在减少立即术后疼痛 (24小时内) 方面比OBA有统计学上显著的优势.
- 目前的证据不支持OFA在早期术后期的止痛效果方面优于OBA.
- 现有研究中的异质性和偏差风险限制了关于OFA有效性的最终结论.
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