Hartling Lisa, Ali Samina, Dryden Donna M, Chordiya Pritam, Johnson David W, Plint Amy C, Stang Antonia, McGrath Patrick J, Drendel Amy L
Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; Women and Children's Health Research Institute, Edmonton, AB, Canada.
Pain Res Manag. 2016;2016:5346819. doi: 10.1155/2016/5346819. Epub 2016 Dec 18.
. Fear of adverse events and occurrence of side effects are commonly cited by families and physicians as obstructive to appropriate use of pain medication in children. We examined evidence comparing the safety profiles of three groups of oral medications, acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids, to manage acute nonsurgical pain in children (<18 years) treated in ambulatory settings. . A comprehensive search was performed to July 2015, including review of national data registries. Two reviewers screened articles for inclusion, assessed methodological quality, and extracted data. Risks (incidence rates) were pooled using a random effects model. . Forty-four studies were included; 23 reported on adverse events. Based on limited current evidence, acetaminophen, ibuprofen, and opioids have similar nausea and vomiting profiles. Opioids have the greatest risk of central nervous system adverse events. Dual therapy with a nonopioid/opioid combination resulted in a lower risk of adverse events than opioids alone. . Ibuprofen and acetaminophen have similar reported adverse effects and notably less adverse events than opioids. Dual therapy with a nonopioid/opioid combination confers a protective effect for adverse events over opioids alone. This research highlights challenges in assessing medication safety, including lack of more detailed information in registry data, and inconsistent reporting in trials.
家庭和医生普遍认为，对不良事件的恐惧以及副作用的出现阻碍了儿童适当使用止痛药物。我们研究了比较三组口服药物（对乙酰氨基酚、非甾体抗炎药和阿片类药物）安全性的证据，以管理在门诊接受治疗的18岁以下儿童的急性非手术疼痛。到2015年7月进行了全面检索，包括对国家数据登记处的审查。两名审查员筛选纳入的文章，评估方法学质量并提取数据。使用随机效应模型汇总风险（发病率）。纳入了44项研究；23项报告了不良事件。基于目前有限的证据，对乙酰氨基酚、布洛芬和阿片类药物的恶心和呕吐情况相似。阿片类药物发生中枢神经系统不良事件的风险最高。非阿片类药物/阿片类药物联合治疗导致不良事件的风险低于单独使用阿片类药物。布洛芬和对乙酰氨基酚报告的不良反应相似，且明显少于阿片类药物。非阿片类药物/阿片类药物联合治疗比单独使用阿片类药物对不良事件具有保护作用。这项研究突出了评估药物安全性方面的挑战，包括登记数据中缺乏更详细的信息以及试验报告不一致。
