Díaz-Heredia J, Loza E, Cebreiro I, Ruiz Iban M Á
Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Ramón y Cajal, Madrid, España.
Instituto de Salud Musculoesquelética, Madrid, España.
Rev Esp Cir Ortop Traumatol. 2015 Mar-Apr;59(2):73-90. doi: 10.1016/j.recot.2014.09.004. Epub 2014 Nov 1.
To analyze the efficacy and safety of preventive analgesia in patients undergoing hip or knee arthroplasty due to osteoarthritis.
A systematic literature review was performed, using a defined a sensitive strategy on Medline, Embase and Cochrane Library up to May 2013. The inclusion criteria were: patients undergoing knee and/or hip arthroplasty, adults with moderate or severe pain (≥4 on a Visual Analog Scale). The intervention, the use (efficacy and safety) of pharmacological treatment (preventive) close to surgery was recorded. Oral, topical and skin patch drugs were included. Systematic reviews, meta-analysis, controlled trials and observational studies were selected.
A total of 36 articles, of moderate quality, were selected. The patients included were representative of those undergoing knee and/or hip arthroplasty in Spain. They had a mean age >50 years, higher number of women, and reporting moderate to severe pain (≥4 on a Visual Analog Scale). Possurgical pain was mainly evaluated with a Visual Analog Scale. A wide variation was found as regards the drugs used in the preventive protocols, including acetaminophen, classic NSAID, Cox-2, opioids, corticosteroids, antidepressants, analgesics for neuropathic pain, as well as others, such as magnesium, ketamine, nimodipine or clonidine. In general, all of them decreased post-surgical pain without severe adverse events.
The use or one or more pre-surgical analgesics decreases the use of post-surgical drugs, at least for short term pain.
分析预防性镇痛在因骨关节炎接受髋或膝关节置换术患者中的疗效和安全性。
进行了一项系统的文献综述，截至2013年5月，在Medline、Embase和Cochrane图书馆采用了明确的敏感策略。纳入标准为：接受膝关节和/或髋关节置换术的患者，中度或重度疼痛的成年人（视觉模拟评分≥4）。记录手术临近时药物治疗（预防性）的使用情况（疗效和安全性）。纳入口服、局部和皮肤贴剂药物。选择系统评价、荟萃分析、对照试验和观察性研究。
共筛选出36篇质量中等的文章。纳入的患者代表了西班牙接受膝关节和/或髋关节置换术的患者。他们的平均年龄>50岁，女性人数较多，报告有中度至重度疼痛（视觉模拟评分≥4）。术后疼痛主要通过视觉模拟评分进行评估。在预防性方案中使用的药物方面发现了很大差异，包括对乙酰氨基酚、经典非甾体抗炎药、环氧化酶-2抑制剂、阿片类药物、皮质类固醇、抗抑郁药、神经性疼痛镇痛药，以及其他药物，如镁、氯胺酮、尼莫地平和可乐定。总体而言，所有这些药物都能减轻术后疼痛，且无严重不良事件。
使用一种或多种术前镇痛药可减少术后药物的使用，至少对于短期疼痛是如此。
