Zhu Alyssa, Benzon Hubert A, Anderson T Anthony
From the *Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; and †Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Anesth Analg. 2017 Nov;125(5):1569-1587. doi: 10.1213/ANE.0000000000002434.
While a large number of studies has examined the efficacy of opioid-sparing analgesics in adult surgical populations, fewer studies are available to guide postoperative pain treatment in pediatric patients. We systematically reviewed available publications on the use of systemic nonopioid agents for postoperative analgesia in pediatric surgical populations. A comprehensive literature search identified meta-analyses and randomized controlled trials (RCTs) assessing the effects of systemic, nonopioid agents on postoperative narcotic requirements or pain scores in pediatric surgical populations. If a meta-analysis was located, we summarized its results and any RCTs published after it. We located and reviewed 11 acetaminophen RCTs, 1 nonsteroidal anti-inflammatory drug (NSAID) meta-analysis, 2 NSAID RCTs, 1 dexamethasone meta-analysis, 3 dexamethasone RCTs, 2 ketamine meta-analyses, 5 ketamine RCTs, 2 gabapentin RCTs, 1 clonidine meta-analysis, 3 magnesium RCTs, 2 dexmedetomidine meta-analyses, and 1 dextromethorphan RCT. No meta-analyses or RCTs were found assessing the perioperative efficacy of intravenous lidocaine, amantadine, pregabalin, esmolol, or caffeine in pediatric surgical patients. The available evidence is limited, but suggests that perioperative acetaminophen, NSAIDs, dexamethasone, ketamine, clonidine, and dexmedetomidine may decrease postoperative pain and opioid consumption in some pediatric surgical populations. Not enough, or no, data exist from which to draw conclusions on the perioperative use of gabapentin, magnesium, dextromethorphan, lidocaine, amantadine, pregabalin, esmolol, and caffeine in pediatric surgical patients. Further pharmacokinetic and pharmacodynamics studies to establish both the clinical benefit and efficacy of nonopioid analgesia in pediatric populations are needed.
虽然大量研究探讨了阿片类药物节省型镇痛药在成年外科患者中的疗效，但针对儿科患者术后疼痛治疗的研究较少。我们系统回顾了关于全身用非阿片类药物用于儿科外科患者术后镇痛的现有文献。全面的文献检索确定了评估全身用非阿片类药物对儿科外科患者术后麻醉需求或疼痛评分影响的荟萃分析和随机对照试验（RCT）。如果找到荟萃分析，我们总结其结果以及之后发表的任何RCT。我们找到了并回顾了11项对乙酰氨基酚RCT、1项非甾体抗炎药（NSAID）荟萃分析、2项NSAID RCT、1项地塞米松荟萃分析、3项地塞米松RCT、2项氯胺酮荟萃分析、5项氯胺酮RCT、2项加巴喷丁RCT、1项可乐定荟萃分析、3项镁剂RCT、2项右美托咪定荟萃分析和1项右美沙芬RCT。未发现评估静脉注射利多卡因、金刚烷胺、普瑞巴林、艾司洛尔或咖啡因在儿科外科患者围手术期疗效的荟萃分析或RCT。现有证据有限，但表明围手术期使用对乙酰氨基酚、NSAIDs、地塞米松、氯胺酮、可乐定和右美托咪定可能会减轻某些儿科外科患者的术后疼痛并减少阿片类药物的使用。关于加巴喷丁、镁剂、右美沙芬、利多卡因、金刚烷胺、普瑞巴林、艾司洛尔和咖啡因在儿科外科患者围手术期的使用，没有足够的数据或根本没有数据可用于得出结论。需要进一步进行药代动力学和药效学研究，以确定非阿片类镇痛在儿科人群中的临床益处和疗效。
