术后口服缓释阿片类药物与口服速释阿片类药物的风险和益处:一项系统回顾和荟萃分析

本文由”罂粟花“授权转载

术后口服缓释阿片类药物与口服速释阿片类药物的风险和益处:一项系统回顾和荟萃分析

目的：尽管有证据表明使用缓释阿片类药物可能会增加不良反应的风险，但使用缓释阿片类药物治疗术后急性疼痛的情况很普遍。这项系统评价和荟萃分析旨在比较口服缓释阿片类药物与速释阿片类药物治疗成人术后疼痛的安全性和有效性。

方法：我们检索了2003年1月1日至2023年1月1日期间的五个电子数据库。其中包括已发表的针对接受手术患者的随机临床试验和观察性研究，研究对术后接受口服缓释阿片类药物的患者与接受口服速释阿片类药物的患者进行了比较。两名评审员独立提取有关安全性（不良事件发生率）和有效性（疼痛强度、术后 12个月内镇痛和阿片类药物的使用以及身体器官功能）和次要结果（住院时间、再入院、心理功能、费用和生活质量）。

结果:在纳入的八篇文章中，五篇是随机临床试验，三篇是观察性研究。证据的总体质量较低。与术后口服速释阿片类药物相比，缓释阿片类药物的使用与更高的不良事件发生率(n = 645，优势比(95%CI) 2.76[1.52-5.04])和更严重的疼痛(n = 550，标准化平均差(95%CI) 0.2[0.04-0.37])相关。  

结论：我们综合得出的结论是，在镇痛药用量、住院时间、再入院或术后身体功能方面，缓释阿片类药物并不比速释阿片类药物优越。一项研究表明，与速释阿片类药物的使用相比，缓释阿片类药物的使用与术后持续使用阿片类药物的比例较高相关。纳入的研究均未报告心理状况、费用或生活质量。

原始文献来源：S. Liu, A. Athar, D. Quach, et, al. Risks and benefits of oral modified-release compared with oral immediate-release opioid use after surgery: a systematic review and meta-analysis. Anaesthesia 2023, doi:10.1111/anae.16085          

英文原文：

Risks and benefits of oral modified-release compared with oral immediate-release opioid use after surgery: a systematic review and meta-analysis

Summary  

Prescription of modified-release opioids for acute postoperative pain is widespread despite evidence to show their use may be associated with an increased risk of adverse effects. This systematic review and meta-analysis aimed to examine the available evidence on the safety and efficacy of modified-release, compared with immediate-release, oral opioids for postoperative pain in adults. We searched five electronic databases from 1 January 2003 to 1 January 2023. Published randomised clinical trials and observational studies on adults who underwent surgery which compared those who received oral modified-release opioids postoperatively with those receiving oral immediate-release opioids were included. Two reviewers independently extracted data on the primary outcomes of safety (incidence of adverse events) and efficacy (pain intensity, analgesic and opioid use, and physical function) and secondary outcomes (length of hospital stay, hospital readmission, psychological function, costs, and quality of life) up to 12 months postoperatively. Of the eight articles included, five were randomised clinical trials and three were observational studies. The overall quality of evidence was low. Modified-release opioid use was associated with a higher incidence of adverse events (n = 645, odds ratio (95%CI) 2.76 (1.52–5.04)) and worse pain (n = 550, standardised mean difference (95%CI) 0.2 (0.04–0.37)) compared with immediate-release opioid use following surgery. Our narrative synthesis concluded that modified-release opioids showed no superiority over immediate-release opioids for analgesic consumption, length of hospital stay, hospital readmissions or physical function after surgery. One study showed that modified-release opioid use is associated with higher rates of persistent postoperative opioid use compared with immediate-release opioid use. None of the included studies reported on psychological function, costs or quality of life.

免责声明：

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。

—END—

编辑：MiSuper.米超

校对：Michel.米萱  

打赏