下肢手术区域麻醉的随机对照试验的临床实用性:一个系统的审查
Danielle Waller1, Josh Saurino2, Adam Khan2
1Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA danielle.waller@okstate.edu.
Regional anesthesia and pain medicine
|October 14, 2025
概括
大多数用于下肢手术的区域麻醉 (RA) 的随机对照试验 (RCT) 缺乏务实设计和经济评估,限制了现实世界的适用性. 提高透明度和开放科学实践可以增强为周围手术区块选择提供高效益证据的生成.
科学领域:
- 麻醉学 麻醉学
- 基于证据的医学是基于证据的医学.
- 临床试验方法论 临床试验方法论
背景情况:
- 区域麻醉 (RA) 对于多模式止痛至关重要.
- 许多支持RA的随机对照试验 (RCT) 缺乏足够严格的基于证据的区块选择.
研究的目的:
- 评估RA的RCT在下肢手术中的临床有用性和透明度.
- 使用了't Hooft等人的货车. 评估的框架.
主要方法:
- 在RA上进行下肢手术的RCT (2014-2024) 的搜索Embase/MEDLINE.
- 使用临床效用和透明度标准提取数据.
- 进行描述性统计,线性/多变量回归和相关性分析.
主要成果:
- 分析了248个RCT;以患者为中心是普遍的,可行性 (77.0%) 和上下文放置 (77.4%) 是常见的.
- 实用主义 (2.0%) 和价值分析 (0%) 是罕见的.
- 随着时间的推移,透明度有所提高,其中88.7%披露冲突,39.9%预先注册,10.1%有公共协议,1.2%共享原始数据.
结论:
- 透明度正在增加,但大多数试验缺乏实用性和经济评估,阻碍了实际应用.
- 排除非英语试验和缺乏偏见分析的正式风险限制了解释性.
- 将资助者/期刊的期望与开放科学和务实设计结合起来,可以加速为外科手术期间区块选择提供高效益的证据.
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