Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada.
Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada.
BMJ Open. 2020 Feb 2;10(1):e035443. doi: 10.1136/bmjopen-2019-035443.
Excessive prescribing after surgery has contributed to a public health crisis of opioid addiction and overdose in North America. However, the value of prescribing opioids to manage postoperative pain after surgical discharge remains unclear. We propose a systematic review and meta-analysis to assess the extent to which opioid analgesia impact postoperative pain intensity and adverse events in comparison to opioid-free analgesia in patients discharged after surgery.
Major electronic databases (MEDLINE, Embase, Cochrane Library, Scopus, AMED, BIOSIS, CINAHL and PsycINFO) will be searched for multi-dose randomised-trials examining the comparative effectiveness of opioid versus opioid-free analgesia after surgical discharge. Studies published from January 1990 to July 2019 will be targeted, with no language restrictions. The search will be re-run before manuscript submission to include most recent literature. We will consider studies involving patients undergoing minor and major surgery. Teams of reviewers will, independently and in duplicate, assess eligibility, extract data and evaluate risk of bias. Our main outcomes of interest are pain intensity and postoperative vomiting. Study results will be pooled using random effects models. When trials report outcomes for a common domain (eg, pain intensity) using different scales, we will convert effect sizes to a common standard metric (eg, Visual Analogue Scale). Minimally important clinical differences reported in previous literature will be considered when interpreting results. Subgroup analyses defined a priori will be conducted to explore heterogeneity. Risk of bias will be assessed according to the Cochrane Collaboration's Risk of Bias Tool 2.0. The quality of evidence for all outcomes will be evaluated using the GRADE rating system.
Ethical approval is not required since this is a systematic review of published studies. Our results will be published in a peer-reviewed journal and presented at relevant conferences. Further knowledge dissemination will be sought via public and patient organisations focussed on pain and opioid-related harms.
在北美，手术后过度开具处方导致阿片类药物成瘾和用药过量成为公共卫生危机。然而，手术后开具阿片类药物来缓解疼痛的价值仍不清楚。我们提出了一项系统评价和荟萃分析，以评估与无阿片类药物镇痛相比，阿片类药物镇痛在术后出院患者中对术后疼痛强度和不良事件的影响程度。
将对多剂量随机试验进行主要电子数据库（MEDLINE、Embase、Cochrane 图书馆、Scopus、AMED、BIOSIS、CINAHL 和 PsycINFO）进行搜索，以检查手术后出院时阿片类药物与无阿片类药物镇痛的比较效果。研究对象为 1990 年 1 月至 2019 年 7 月发表的多剂量随机试验，无语言限制。在提交手稿之前，我们将重新进行搜索，以纳入最新的文献。我们将考虑涉及接受小手术和大手术的患者的研究。评审小组将独立并重复评估合格性、提取数据和评估偏倚风险。我们主要关注的结果是疼痛强度和术后呕吐。将使用随机效应模型汇总研究结果。当试验使用不同的量表报告共同领域（例如，疼痛强度）的结果时，我们将把效应大小转换为共同的标准度量（例如，视觉模拟量表）。将考虑先前文献中报告的最小临床重要差异来解释结果。将进行预先定义的亚组分析以探索异质性。将根据 Cochrane 合作风险偏倚工具 2.0 评估风险偏倚。将使用 GRADE 评级系统评估所有结局的证据质量。
由于这是对已发表研究的系统评价，因此不需要伦理批准。我们的结果将发表在同行评议的期刊上，并在相关会议上展示。我们将通过专注于疼痛和阿片类药物相关危害的公共和患者组织进一步传播知识。
