Discipline of General Practice, School of Medicine, University of Queensland, Herston, Australia.
Pain Med. 2012 May;13(5):711-27. doi: 10.1111/j.1526-4637.2012.01359.x. Epub 2012 Apr 11.
This study aimed to determine which analgesic modalities used following discharge have the greatest efficacy in reducing postoperative pain after elective non-axial orthopedic surgery.
A systematic review was conducted using the databases CENTRAL, MEDLINE, and EMBASE, as well as clinical practice guidelines databases and trial registries. Titles and abstracts were perused by two reviewers for randomized clinical trials in English fulfilling inclusion and exclusion criteria. Quality assessments, including the Oxford Quality Score, selective reporting, and sources of funding, were also performed.
Pain intensity/relief, global patient evaluation, and use of rescue analgesia, as well as adverse events and withdrawals.
2,167 articles were retrieved and 23 articles were eligible for inclusion. They investigated analgesic modalities including alternative therapies (5); cyclooxygenase-2 inhibitors (3); nonselective, nonsteroidal anti-inflammatory drugs (NSAIDs) (12); opioids (2); and other pharmaceutical classes (1). Cycooxygenase-2 inhibitors and opioids demonstrated significant efficacy with minimal side effects. Most nonselective NSAIDs were effective analgesics but had a poorer side-effect profile. Alternative therapies demonstrated no significant efficacy.
Opioids and cyclooxygenase-2 inhibitors are effective in providing analgesia in the extended postoperative period following orthopedic surgery with a minimal side-effect profile, while nonselective NSAIDs need to be treated with caution. Homeopathy is not an effective analgesic, while acupuncture has varied evidence and effectiveness. Treatment of postoperative fatigue may also improve analgesia control. This study provides orthopedic surgeons with a basis for evidence-based prescribing of postdischarge analgesia. However, further studies to validate these results against modern reporting standards are needed.
本研究旨在确定在择期非轴向骨科手术后出院后使用何种镇痛方式能最大程度地减轻术后疼痛。
使用 CENTRAL、MEDLINE 和 EMBASE 数据库以及临床实践指南数据库和试验注册处进行系统评价。两名评审员浏览了符合纳入和排除标准的英文随机临床试验的标题和摘要。还进行了质量评估，包括牛津质量评分、选择性报告和资金来源。
疼痛强度/缓解、总体患者评估和使用解救性镇痛以及不良事件和退出情况。
共检索到 2167 篇文章，有 23 篇文章符合纳入标准。它们调查了包括替代疗法（5 篇）；环氧化酶-2 抑制剂（3 篇）；非选择性、非甾体抗炎药（NSAIDs）（12 篇）；阿片类药物（2 篇）和其他药物类别（1 篇）在内的镇痛方式。环氧化酶-2 抑制剂和阿片类药物具有显著的疗效且副作用最小。大多数非选择性 NSAIDs 是有效的镇痛药，但副作用谱较差。替代疗法没有显示出明显的疗效。
阿片类药物和环氧化酶-2 抑制剂在骨科手术后的延长术后期间提供有效的镇痛，副作用最小，而非选择性 NSAIDs 需要谨慎使用。顺势疗法不是一种有效的镇痛药，而针灸有不同的证据和疗效。治疗术后疲劳也可能改善镇痛控制。本研究为骨科医生提供了基于证据的出院后镇痛处方的基础。然而，需要进一步的研究来根据现代报告标准验证这些结果。
