非阿片类镇痛药预防术后慢性疼痛的系统评价和荟萃分析

以下文章来源于罂粟花 ，作者anesthGH

本文由“罂粟花”授权转载

非阿片类镇痛药预防术后慢性疼痛的系统评价和荟萃分析

贵州医科大    麻醉与心脏电生理课题组

翻译：宋雨婷

编辑：柏雪

审校：曹莹

背景：

慢性术后疼痛在手术后很常见。研究具有预防慢性术后疼痛的非阿片类镇痛药很重要，尽管试验通常效力不足。荟萃分析提供了一个机会来提高功效并确定最有希望用于临床和未来研究的疗法。

方法：

本试验对非阿片类镇痛药治疗术后慢性疼痛的随机对照试验进行PRISMA-NMA标准的系统评价和荟萃分析。结局指标包括术后慢性疼痛的发生率和严重程度、严重不良事件发生情况和慢性阿片类药物使用情况。

结果：

本研究共纳入132项随机对照试验，涉及23902名受试者。按疗效进行排序，静脉注射利多卡因（比值比 [OR] 0.32；95% 可信区间 [CrI] 0.17–0.58）、氯胺酮（OR 0.64；95% CrI 0.44–0.92）、加巴喷丁类药物（OR 0.67；95% CrI 0.47–0.92）和右美托咪定（OR 0.36；95% CrI 0.12–1.00）均降低了≤6 个月术后慢性疼痛的发生率。关于>6个月的术后慢性疼痛、联合用药、慢性阿片类药物使用和严重不良事件的证据较少。可变基线风险可能与荟萃分析传递性假设相悖，因此根据此固定值报告结果，镇痛药在较高的基线风险下更有效。 由于偏倚风险和不精确性的问题，这些研究的可信度较低。

结论：

利多卡因（最有效）、氯胺酮和加巴喷丁类药物可有效减轻≤6个月的术后慢性疼痛，但可信度较低。此外，可变基线风险可能与荟萃分析传递性假设相悖，建议在未来的荟萃分析中使用此次研究方法。

原始文献来源：

Doleman B, Mathiesen O, Sutton AJ, Cooper NJ, Lund JN, Williams JP. Non-opioid analgesics for the prevention of chronic postsurgical pain: a systematic review and network meta-analysis. Br J Anaesth. 2023;130(6):719-728. doi:10.1016/j.bja.2023.02.041

英文原文：

Non-opioid analgesics for the prevention of chronic postsurgical pain: a systematic review and network meta-analysis  

Background: Chronic postsurgical pain is common after surgery. Identification of non-opioid analgesics with potential for preventing chronic postsurgical pain is important, although trials are often underpowered. Network meta-analysis offers an opportunity to improve power and to identify the most promising therapy for clinical use and future studies. 

Methods: We conducted a PRISMA-NMA-compliant systematic review and network meta-analysis of randomised controlled trials of non-opioid analgesics for chronic postsurgical pain. Outcomes included incidence and severity of chronic postsurgical pain, serious adverse events, and chronic opioid use.

Results: We included 132 randomised controlled trials with 23 902 participants. In order of efficacy, i.v. lidocaine (odds ratio [OR] 0.32; 95% credible interval [CrI] 0.17–0.58), ketamine (OR 0.64; 95% CrI 0.44–0.92), gabapentinoids (OR 0.67; 95% CrI 0.47–0.92), and possibly dexmedetomidine (OR 0.36; 95% CrI 0.12–1.00) reduced the incidence of chronic postsurgical pain at ≤6 months. There was little available evidence for chronic postsurgical pain at >6 months, combinations agents, chronic opioid use, and serious adverse events. Variable baseline risk was identified as a potential violation to the network meta-analysis transitivity assumption, so results are reported from a fixed value of this, with analgesics more effective at higher baseline risk. The confidence in these findings was low because of problems with risk of bias and imprecision.

Conclusions: Lidocaine (most effective), ketamine, and gabapentinoids could be effective in reducing chronic postsurgical pain ≤6 months although confidence is low. Moreover, variable baseline risk might violate transitivity in network meta-analysis of analgesics; this recommends use of our methods in future network meta-analyses.

免责声明：

本公众平台所刊载原创或转载内容不代表米勒之声的观点或立场。文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：MiSuper.米超

校对：Michel.米萱

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