髋关节和膝关节置换术后疼痛管理试验中阿片类和非阿片类药物联合使用的多模式镇痛治疗：一项荟萃流行病学研究

贵州医科大学麻醉与心脏电生理课题组

翻译 : 马艳燕

编辑 : 严旭

审校 : 曹莹

背景：围手术期疼痛管理的主要原则是多模式镇痛，可减少阿片类药物需求和相关不良反应。务实的疼痛试验应在多模式非阿片类镇痛药和干预措施之外，对干预措施进行最佳测试，以确保临床相关性和反映临床环境的阿片类药物消耗基础水平。我们旨在调查全髋关节和膝关节置换术后疼痛试验中辅助使用阿片类药物和非阿片类镇痛药的使用情况。

方法：2020年1月7日在CENTRAL(Cochrane图书馆)、PubMed和EMBASE数据库中进行了系统的文献检索。对成人全髋关节或膝关节置换术后疼痛的镇痛干预进行了试验研究。主要结局是术后0-24小时阿片类药物消耗的累计中位数。此外，我们评估了扑热息痛、非甾体抗炎药、加巴喷丁、大剂量糖皮质激素、局部浸润镇痛和神经阻滞作为联合干预措施对所有受试者的使用情况。并评估了所有结局随时间推移的趋势。

结果：在14200条记录中，纳入了570项试验。在髋关节和膝关节置换术试验中，0-24小时阿片类药物消耗的中位数分别为21和22 mg 吗啡静脉注射。meta回归分析显示阿片类药物消耗与出版年份之间没有总体线性相关性。多模式非阿片类镇痛的使用随着时间的推移而增加，尽管在2010年至2020年发表的试验中，只有48%使用了两种或两种以上的非阿片类镇痛药。在干预组中，使用更多的非阿片类镇痛药与阿片类药物消耗较少有关。

结论：术后0-24小时吗啡消耗量中位数为21-22mg。在研究和临床使用中，非阿片类多模式镇痛方案的明显差异，这可能会削弱在临床使用中实施试验干预所证明的阿片类药物的节省效果。

原始文献来源 ： 

Pedersen C, Vilhelmsen FJ, Laigaard J, Mathiesen O, Karlsen APH. Opioid consumption and non-opioid multimodal analgesic treatment in pain management trials after hip and knee arthroplasties: A meta-epidemiological study. Acta Anaesthesiol Scand. 2023 May;67(5):613-620. doi: 10.1111/aas.14213. 

英文原文

Opioid consumption and non-opioid multimodal analgesic treatment in pain management trials after hip and knee arthroplasties: A meta-epidemiological study

Background：The leading principle in peri-operative pain management is multimodal analgesia, which reduces opioid requirements and associated adverse effects. Pragmatic pain trials should optimally test interventions in addition to multimodal non-opioid analgesics and interventions to ensure clinical relevance and baseline levels of opioid consumption that reflect clinical settings. We aimed to investigate opioid consumption and use of non-opioid analgesics administered adjunct to interventions in post-operative pain trials after total hip and knee arthroplasty.

Methods：A systematic literature search was conducted 7 January 2020 in The Cochrane Library's CENTRAL, PubMed, and EMBASE. Trials investigating analgesic interventions for post-operative pain in adults undergoing total hip or knee arthroplasty were included. The primary outcome was the aggregated median 0–24 h post-operative opioid consumption. Further, we assessed the use of paracetamol, non-steroidal anti-inflammatory drugs, gabapentinoids, high-dose glucocorticoids, local infiltration analgesia and nerve blocks administered as co-interventions equally to all participants. We assessed trends over time for all outcomes.

Results：Of 14,200 records, 570 trials were included. Median 0–24 h opioid consumption was 21 and 22 mg iv morphine equivalents in hip and knee arthroplasty trials, respectively. Meta-regression showed no overall linear correlation between opioid consumption and publication year. The use of multimodal non-opioid analgesia increased over time, though only 48% of trials published from 2010 to 2020 administered two or more non-opioid analgesics. Applying more non-opioid analgesics was associated with lower opioid consumption in intervention groups.

Conclusion:Post-operative 0–24 morphine consumption was median 21–22 mg. The demonstrated differences in non-opioid multimodal analgesic regimens between research and clinical settings, can potentially diminish the demonstrated opioid-sparing effects of trial interventions when such are implemented in a clinical context.

来源 | 健康界

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