在明确的手术诊断之前，是否使用阿片类镇痛药治疗急性腹痛？一项系统评价和网状Meta分析

To Use or Not to Use Opioid Analgesia for Acute Abdominal Pain Before Definitive Surgical Diagnosis? A Systematic Review and Network Meta-Analysis.

作者信息

Gavriilidis Paschalis, de'Angelis Nicola, Tobias Aurelio

机构信息

Department of General and Colorectal Surgery, Northern Lincolnshire and Goole, Diana, Princess of Wales Hospital, Scartho Road, Grimsby DN33 2BA, UK.

Department of Digestive Surgery, Henri Mondor University Hospital, 94010 Creteil, France.

出版信息

J Clin Med Res. 2019 Feb;11(2):121-126. doi: 10.14740/jocmr3690. Epub 2019 Jan 5.

DOI:10.14740/jocmr3690

PMID:30701004

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6340675/

Abstract

BACKGROUND

Despite the existing evidence, many physicians are reluctant to use opioid analgesia for acute abdominal pain.

METHODS

We performed updated conventional and network meta-analyses. For the first time to our knowledge, direct and indirect evidence of any type of opioid analgesia was estimated and compared using network meta-analysis.

RESULTS

There was no significant difference in the intensity of pain between the two cohorts (mean difference (MD) = 0.43 (-0.05 to 0.91), P = 0.08). In addition, no significant difference was detected in the rate of incorrect diagnoses between the opioid analgesia and the placebo cohorts (odds ratio (OR) = 0.79 (0.54 to 1.17), P = 0.24). Network meta-analysis demonstrated that the results of direct evidence of head-to-head comparisons of opioid analgesics with placebo were in accordance with the results of conventional meta-analysis. Moreover, estimation and comparison of the indirect evidence on the four opioid analgesics did not demonstrate significant differences in effect size.

CONCLUSIONS

Any type of opioid analgesic can be used safely for acute abdominal pain without risk of impairment of diagnostic accuracy.

摘要

背景

尽管已有证据，但许多医生仍不愿将阿片类镇痛药用于急性腹痛。

方法

我们进行了更新的传统和网状荟萃分析。据我们所知，首次使用网状荟萃分析对任何类型阿片类镇痛的直接和间接证据进行了估计和比较。

结果

两组之间的疼痛强度无显著差异（平均差（MD）=0.43（-0.05至0.91），P = 0.08）。此外，阿片类镇痛组与安慰剂组之间的误诊率未检测到显著差异（比值比（OR）=0.79（0.54至1.17），P = 0.24）。网状荟萃分析表明，阿片类镇痛药与安慰剂进行直接比较的直接证据结果与传统荟萃分析结果一致。此外，对四种阿片类镇痛药间接证据的估计和比较未显示效应大小有显著差异。