Pain Research and Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurology, University of Oxford, Oxford, United Kingdom.
Novartis Healthcare Pvt Ltd, Salarpuria Sattva Knowledge City, Hyderabad, India.
Pain. 2018 Nov;159(11):2234-2244. doi: 10.1097/j.pain.0000000000001322.
Network meta-analysis uses direct comparisons of interventions within randomized controlled trials and indirect comparisons across them. Network meta-analysis uses more data than a series of direct comparisons with placebo, and theoretically should produce more reliable results. We used a Cochrane overview review of acute postoperative pain trials and other systematic reviews to provide data to test this hypothesis. Some 261 trials published between 1966 and 2016 included 39,753 patients examining 52 active drug and dose combinations (27,726 given active drug and 12,027 placebo), in any type of surgery (72% dental). Most trials were small; 42% of patients were in trials with arms <50 patients, and 27% in trials with arms ≥100 patients. Response to placebo in third molar extraction fell by half in studies over 30 to 40 years (171 trials, 7882 patients given placebo). Network meta-analysis and Cochrane analyses provided very similar results (average difference 0.04 number needed to treat units), with no significant difference for almost all comparisons apart from some with small patient numbers or small effect size, or both. Network meta-analysis did not detect significant differences between effective analgesics. The similarity between network meta-analysis and Cochrane indirect analyses probably arose from stringent quality criteria in trials accepted in Cochrane reviews (with consequent low risk of bias) and consistency in methods and outcomes. Network meta-analysis is a useful analytical tool that increases our confidence in estimates of efficacy of analgesics in acute postoperative pain, in this case by providing similar results.
网络荟萃分析使用随机对照试验内的直接比较和它们之间的间接比较。网络荟萃分析比一系列与安慰剂的直接比较使用更多的数据，并且理论上应该产生更可靠的结果。我们使用急性术后疼痛试验的 Cochrane 综述和其他系统评价来提供数据以检验这一假设。1966 年至 2016 年间发表的约 261 项试验包括 39753 名患者，研究了 52 种活性药物和剂量组合（27726 种给予活性药物，12027 种给予安慰剂），涉及任何类型的手术（72%为牙科）。大多数试验规模较小；42%的患者参加了臂小于 50 名患者的试验，27%参加了臂大于或等于 100 名患者的试验。在 30 至 40 年间的 171 项试验（7882 名患者给予安慰剂）中，接受第三磨牙拔除的患者对安慰剂的反应下降了一半。网络荟萃分析和 Cochrane 分析提供了非常相似的结果（平均差异 0.04 需要治疗的患者数），除了一些患者数量较小或效应大小较小的比较外，几乎没有差异，或者两者兼而有之。网络荟萃分析没有发现有效镇痛剂之间的显著差异。网络荟萃分析和 Cochrane 间接分析之间的相似性可能源于 Cochrane 综述中接受的试验的严格质量标准（因此偏差风险较低）以及方法和结果的一致性。网络荟萃分析是一种有用的分析工具，通过提供类似的结果，增加了我们对急性术后疼痛中镇痛剂疗效估计的信心。
