在结肠直肠外科手术中预防性与术后止痛:系统性审查和元分析
Omar Saeed1, Abdelrahman Saeed1, Sara Saleh2
1Faculty of Medicine, Al-Azhar University, Damietta, Egypt.
World journal of surgery
|November 25, 2025
概括
结肠直肠手术中的预防性止痛可以在24小时内降低疼痛评分,但不能降低阿片类药物的使用. 与术后止痛相比,它在长期疼痛,住院或不良事件方面没有显著差异.
科学领域:
- 麻醉学和疼痛管理
- 手术瘤学手术瘤学
- 基于证据的医学基于证据的医学.
背景情况:
- 预防性镇痛旨在通过阻断外科刺激之前的感觉输入来减少疼痛.
- 它有可能在接受结直肠手术的患者中改善术后恢复.
- 这项研究评估了预防性与术后止痛疗法的有效性和安全性.
研究的目的:
- 评估预防性止痛疗法的有效性与术后止痛疗法的有效性.
- 确定对疼痛评分,阿片类药物消费和康复结果的影响.
- 评估在结直肠外科手术中预防性止痛的安全性.
主要方法:
- 在主要数据库 (PubMed,Scopus,Web of Science,Cochrane Library) 进行系统搜索,截至2025年5月.
- 包括随机对照试验 (RCT),比较成人结直肠手术患者的预防性和术后性止痛.
- 主要结局:24小时的阿片类药物消耗和24/48小时的VAS疼痛得分;次要结局:不良事件,住院,PONV.
主要成果:
- 包括7个RCT,包括625名患者 (312名预防,313名术后).
- 预防性止痛疗法在24小时内显著降低了VAS疼痛得分 (MD -0.45,p=0.04).
- 两组之间48小时或24小时阿片类药物消费后的VAS得分没有发现显著差异.
结论:
- 预防性止痛药并没有减少结直肠手术患者24小时的阿片类药物消耗.
- 它在术后24小时有效降低了VAS疼痛得分.
- 在长期疼痛,住院或不良事件 (包括PONV) 中没有发现显著差异.
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