骨科手术中与非类固醇抗炎药相关的严重不良事件的风险：一项系统性回顾研究

骨科手术中与非类固醇抗炎药相关的严重不良事件的风险：一项系统性回顾研究

贵州医科大学     麻醉与心脏电生理课题组

翻译：马艳燕  编辑：张中伟  审核：曹莹

罂 粟 摘 要 

背景：术后疼痛是骨科手术后的一种常见症状，这会导致住院时间延长，康复时间推迟，并影响生活质量。非甾体抗炎药（NSAIDs）是治疗术后疼痛的有效镇痛剂和抗炎剂。然而，NSAIDs与严重不良事件的关联可能使一些临床医生和临床决策者不敢在围手术期使用NSAIDs。在骨科手术中围手术期使用NSAIDs后发生严重不良事件的风险的证据很少，需要在系统的回顾中进行评估。这是一项系统回顾性研究，旨在确定骨科患者围手术期使用NSAIDs的严重不良事件的风险。

方法：基于《系统回顾和Meta分析协议的首选报告项目》和Jakobsen及其同事建议的八步评估程序。评估非甾体抗炎药与安慰剂、常规护理或无干预措施相比，是否会影响骨科手术患者发生严重不良事件的风险。纳入所有评估围手术期使用NSAIDs的随机试验。为了确定试验，在医学文献分析和检索系统、Excerpta Medica数据库、Cochrane中心注册表，在Web of Science和BIOSIS进行搜索。两位作者对文献进行筛选并提取数据,使用RoB2进行评估。提取的数据使用RStudio和试验顺序分析法进行分析。我们将创建一个“研究结果摘要”表，在该表中展示主要和次要结果。使用GRADE分级来评估证据的质量。

讨论：这一系统性综述可能有助于临床医生和临床决策者使用NSAIDs治疗骨科手术的术后疼痛。

原始文献来源：Leth MF, Bukhari S, Laursen CCW, Larsen ME, Tornøe AS, Jakobsen JC, Maagaard M, Mathiesen O. Risk of serious adverse events associated with non-steroidal anti-inflammatory drugs in orthopaedic surgery. A protocol for a systematic review. Acta Anaesthesiol Scand. 2022 Aug 20. doi: 10.1111/aas.14140.

英文原文 

Risk of serious adverse events associated with non-steroidal anti-inflammatory drugs in orthopaedic surgery. A protocol for a systematic review

Background:  Postoperative pain is a common condition following orthopaedic surgeries and causes prolonged hospitalisation, delayed rehabilitation and hamper the quality of life. Non-steroidal anti-inflammatory drugs (NSAIDs) are effective analgesics and anti-inflammatory mediators in the treatment of postoperative pain. The association of NSAIDs with serious adverse events may however keep some clinicians and clinical decision makers from using NSAIDs perioperatively. The evidence regarding the risks of serious adverse events following perioperative use of NSAIDs in orthopaedic surgery is sparse and needs to be assessed in a systematic review. This is a protocol for a systematic review that aims to identify the risks of serious adverse events from perioperative use of NSAIDs in orthopaedic patients.

Methods：Our methodology is based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and the eight-step assessment procedure suggested by Jakobsen and colleagues. We wish to assess if NSAIDs versus placebo, usual care or no intervention, will influence the risks of serious adverse events in patients undergoing orthopaedic surgery. We will include all randomised trials assessing the use of NSAIDs perioperatively. To identify trials we will search the Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Cochrane Central Register, Science Citation Index Expanded on Web of Science and BIOSIS. Two authors will screen the literature and extract data. We will use the 'Risk of Bias 2 tool' to assess trials. Extracted data will be analysed using RStudio and Trial Sequential Analysis. We will create a 'Summary of Findings' table in which we will present our primary and secondary outcomes. We will assess the quality of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Discussion: This systematic review can potentially aid clinicians and clinical decision makers in the use of NSAIDs for treatment of postoperative pain following orthopaedic surgeries.