Zeng Angela M, Nami Nina F, Wu Christopher L, Murphy Jamie D
From the Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University and School of Medicine, Baltimore, MD.
Reg Anesth Pain Med. 2016 Nov/Dec;41(6):763-772. doi: 10.1097/AAP.0000000000000460.
Postoperative pain after cesarean delivery, which accounts for approximately 1 in 3 live births in the United States, can be severe in many patients. Nonsteroidal anti-inflammatory agents (NSAIDs) are potent analgesics that are effective in the treatment of postoperative pain. In this meta-analysis, we assessed the analgesic efficacy of NSAIDs in postoperative cesarean delivery patients.
An electronic literature search of the Library of Medicine's PubMed, Cochrane CENTRAL, Scopus, and EMBASE databases was conducted in May 2013 and updated in January 2015 (Appendix, Supplemental Digital Content 1, http://links.lww.com/AAP/A174). Searches were limited to randomized controlled trials. The primary outcome variable was visual analog scale or numerical rating scale pain scores. Secondary outcomes included cumulative postoperative opioid consumption and opioid-related adverse effects (drowsiness/sedation, nausea, and vomiting). Data extraction was performed independently by 2 reviewers. Extracted data were input into Review Manager.
Twenty-two randomized controlled trials compared a NSAID (n = 639) to a control (n = 674). Patients in the NSAID group versus control reported lower pain scores at 12 hours (P = 0.003) and at 24 hours (P < 0.001). Subgroup analysis showed a significant difference in pain scores at 24 hours, with patients receiving NSAIDs via intravenous/intramuscular (P < 0.001) route, but not the oral (P = 0.39) or rectal routes (P = 0.99). Significantly lower average pain scores were reported for pain with movement at 24 hours in the NSAID group (P = 0.001). Patients in the NSAID group versus controls consumed significantly less opioids (P < 0.001) and had significantly less drowsiness/sedation (P = 0.03), but there was no significant difference between the groups with regard to nausea or vomiting (P = 0.48 and P = 0.17, respectively).
The perioperative use of NSAIDs in cesarean delivery patients will result in a significantly lower pain scores, less opioid consumption, and less drowsiness/sedation but no difference in nausea or vomiting compared to those who did not receive NSAIDs. Further research should address the optimal NSAID regimen and examine the effect of improved analgesia on patient-centered outcomes such as patient satisfaction and quality of breastfeeding.
剖宫产术后疼痛在美国约占每三例活产中的一例，许多患者的疼痛会很严重。非甾体类抗炎药（NSAIDs）是有效的镇痛药，对术后疼痛治疗有效。在这项荟萃分析中，我们评估了NSAIDs对剖宫产术后患者的镇痛效果。
2013年5月对医学图书馆的PubMed、Cochrane CENTRAL、Scopus和EMBASE数据库进行了电子文献检索，并于2015年1月更新（附录，补充数字内容1，http://links.lww.com/AAP/A174）。检索限于随机对照试验。主要结局变量是视觉模拟量表或数字评定量表的疼痛评分。次要结局包括术后阿片类药物累计消耗量及阿片类药物相关不良反应（嗜睡/镇静、恶心和呕吐）。由2名审阅者独立进行数据提取。提取的数据输入Review Manager。
22项随机对照试验比较了NSAIDs组（n = 639）和对照组（n = 674）。NSAIDs组患者与对照组相比，在12小时（P = 0.003）和24小时（P < 0.001）时疼痛评分更低。亚组分析显示，在24小时时疼痛评分有显著差异，接受静脉/肌肉注射（P < 0.001）途径NSAIDs的患者有差异，但口服（P = 0.39）或直肠途径（P = 0.99）的患者无差异。NSAIDs组在24小时时活动时疼痛的平均评分显著更低（P = 0.001）。NSAIDs组患者与对照组相比消耗的阿片类药物显著更少（P < 0.001），嗜睡/镇静显著更少（P = 0.03），但两组在恶心或呕吐方面无显著差异（分别为P = 0.48和P = 0.17）。
与未接受NSAIDs的剖宫产患者相比，围手术期使用NSAIDs可使疼痛评分显著降低、阿片类药物消耗量减少、嗜睡/镇静减少，但在恶心或呕吐方面无差异。进一步的研究应探讨最佳NSAIDs方案，并研究改善镇痛对以患者为中心的结局（如患者满意度和母乳喂养质量）的影响。
