氯胺酮用于脊柱手术后疼痛治疗：Meta分析和试验序贯分析的系统评价

以下文章来源于罂粟花 ，作者anesthGH

本文由“罂粟花”授权转载  

氯胺酮用于脊柱手术后疼痛治疗：Meta分析和试验序贯分析的系统评价

背景：

本试验旨在评估使用氯胺酮治疗脊柱手术患者围手术期疼痛的有益和有害影响。  

方法：

我们检索了Medline、Embase和CENTRAL，从开始到2023年2月15日，以查找氯胺酮与安慰剂或不干预治疗脊柱手术患者的随机临床试验。主要结局指标是术后24小时累积阿片类药物使用量和严重不良事件。我们坚持Cochrane协作网的建议，并进行了meta分析和试验序贯分析（TSA）来评估随机错误的风险，用偏倚风险评估来评估系统错误的风险，并使用GRADE。  

结果：

本试验共纳入了28项随机临床试验，涉及2110名受试者，为我们预定的结局提供了数据。23项试验招募了成人受试者，5项试验招募了儿童受试者。三项试验的偏倚风险较低。包括成人在内的试验的Meta分析和TSA表明，氯胺酮与安慰剂或无干预相比，似乎减少了术后24小时阿片类药物的累积使用量（平均差异17.57 mg;TSA 调整后的95%置信区间，-24.22至 -10.92；P <0.01;证据质量低），没有证据表明氯胺酮与安慰剂或不干预在严重不良事件风险方面存在差异（风险比2.16；96.7%置信区间，0.35至13.17；P =0.36；证据质量极低）。

结论：

在接受脊柱手术的成年人中，氯胺酮可能会减少术后24小时阿片类药物使用量。氯胺酮可能会增加严重不良事件的发生，但证据非常不确定。

原始文献来源：

Tornøe AS, Pind AH, Laursen CCW, Andersen C, Maagaard M, Mathiesen O. Ketamine for postoperative pain treatment in spinal surgery: Systematic review with meta-analysis and trial sequential analysis. Acta Anaesthesiol Scand. 2023 Jul 19.  

英文原文

Ketamine for postoperative pain treatment in spinal surgery: Systematic review with meta-analysis and trial sequential analysis

Aim: We aimed to assess the beneficial and harmful effects of perioperative pain treatment with ketamine in patients undergoing spinal surgery.  

Methods: We searched Medline, Embase, and CENTRAL from inception until 15 February 2023 for randomised clinical trials comparing ketamine with placebo or no intervention in patients undergoing spinal surgery. The primary outcomes were cumulative opioid consumption at 24 h postoperatively and serious adverse events. We adhered to recommendations of the Cochrane Collaboration and performed meta-analysis, Trial Sequential Analysis (TSA) to assess the risks of random errors, risk of bias assessment to evaluate the risks of systematic errors, and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE).    

Results: We included a total of 28 randomised clinical trials enrolling 2110 participants providing data for our pre-defined outcomes. Twenty-three trials enrolled adult participants and 5 trials enrolled paediatric participants. Three trials were at low risk of bias. Meta-analysis and TSA of trials including adults showed that ketamine versus placebo or no intervention seemed to reduce the cumulative 24-h opioid consumption (mean difference-17.57 mg; TSA-adjusted 95% confidence interval, 24.22 to 10.92; p < .01; low certainty of evidence), and there was no evidence of a difference of ketamine versus placebo or no intervention on the risk of serious adverse events (risk ratio 2.16; 96.7% confidence interval, 0.35 to 13.17; p = .36; very low certainty of evidence).    

Conclusion: In adults undergoing spinal surgery, ketamine may reduce cumulative 24-h opioid consumption. Ketamine may increase the occurrence of serious adverse events, but the evidence was very uncertain.  

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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