Bakker Caitlin J, Wise Kelsey L, Williams Benjamin R, Swiontkowski Marc F
Health Sciences Libraries (C.J.B.) and Department of Orthopaedic Surgery (K.L.W., B.R.W., and M.F.S.), University of Minnesota, Minneapolis, Minnesota.
TRIA Orthopaedic Center, Bloomington, Minnesota.
J Bone Joint Surg Am. 2020 May 20;102 Suppl 1:36-46. doi: 10.2106/JBJS.19.01439.
The treatment of postoperative pain is an ongoing challenge for orthopaedic surgeons. Poorly controlled pain is associated with poorer patient outcomes, and the prescription of opioids may lead to prolonged, nonmedical use. Complementary and alternative medicine is widely adopted by the general public, and its use in chronic musculoskeletal pain conditions has been studied; however, its efficacy in a postoperative context has not yet been established.
We conducted a systematic literature review of 10 databases to identify all relevant publications. We extracted variables related to pain measurement and postoperative opioid prescriptions.
We identified 8 relevant publications from an initial pool of 2,517 items. Of these, 5 were randomized studies and 3 were nonrandomized studies. All 8 studies addressed postoperative pain, with 5 showing significant decreases (p < 0.05) in postoperative pain. Also, 5 studies addressed postoperative opioid use, with 2 showing significant differences (p < 0.05) in opioid consumption. Substantial heterogeneity among the studies precluded meta-analysis. No articles were found to be free of potential bias.
Currently, there is insufficient evidence to determine the efficacy of complementary and alternative medicines for postoperative pain management or as an alternative to opioid use following orthopaedic surgery.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
术后疼痛的治疗一直是骨科医生面临的挑战。疼痛控制不佳与患者预后较差相关，而阿片类药物的处方可能导致长期的非医疗使用。补充和替代医学被公众广泛采用，其在慢性肌肉骨骼疼痛病症中的应用已得到研究；然而，其在术后情况下的疗效尚未确定。
我们对10个数据库进行了系统的文献综述，以识别所有相关出版物。我们提取了与疼痛测量和术后阿片类药物处方相关的变量。
我们从最初的2517篇文献中识别出8篇相关出版物。其中，5篇为随机研究，3篇为非随机研究。所有8项研究均涉及术后疼痛，其中5项显示术后疼痛显著减轻（p<0.05）。此外，5项研究涉及术后阿片类药物的使用，其中2项显示阿片类药物消耗量存在显著差异（p<0.05）。研究之间存在大量异质性，无法进行荟萃分析。未发现无潜在偏倚的文章。
目前，尚无足够证据确定补充和替代医学在骨科手术后疼痛管理中的疗效，或作为阿片类药物使用的替代方法。
治疗性三级。有关证据级别的完整描述，请参阅作者指南。
