Kendall Mark C, Alves Lucas J, Pence Kristi, Mukhdomi Taif, Croxford Daniel, De Oliveira Gildasio S
Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Anesthesiol Res Pract. 2020 Mar 27;2020:6974321. doi: 10.1155/2020/6974321. eCollection 2020.
We performed a quantitative systematic review of randomized controlled trials in PubMed, Embase, Cochrane Library, and Google Scholar electronic databases. Meta-analysis was performed using the random effects model, weighted mean differences (WMD), standard deviation, 95% confidence intervals, and sample size. Methodological quality was evaluated using Cochrane Collaboration's tool.
Seven randomized controlled trials evaluating 337 patients across different surgical procedures were included. The aggregated effect of intraoperative methadone on postoperative opioid consumption did not reveal a significant effect, WMD (95% CI) of -0.51 (-1.79 to 0.76), (=0.43) IV morphine equivalents. In contrast, the effect of methadone on postoperative pain demonstrated a significant effect in the postanesthesia care unit, WMD (95% CI) of -1.11 (-1.88 to -0.33), =0.005, and at 24 hours, WMD (95% CI) of -1.35 (-2.03 to -0.67), < 0.001.
The use of intraoperative methadone reduces postoperative pain when compared to morphine. In addition, the beneficial effect of methadone on postoperative pain is not attributable to an increase in postsurgical opioid consumption. Our results suggest that intraoperative methadone may be a viable strategy to reduce acute pain in surgical patients.
我们在PubMed、Embase、Cochrane图书馆和谷歌学术电子数据库中对随机对照试验进行了定量系统评价。采用随机效应模型、加权平均差（WMD）、标准差、95%置信区间和样本量进行荟萃分析。使用Cochrane协作工具评估方法学质量。
纳入了7项评估不同手术程序的337例患者的随机对照试验。术中使用美沙酮对术后阿片类药物消耗的总体影响未显示出显著效果，WMD（95%CI）为-0.51（-1.79至0.76），相当于0.43静脉注射吗啡当量。相比之下，美沙酮对术后疼痛的影响在麻醉后护理单元显示出显著效果，WMD（95%CI）为-1.11（-1.88至-0.33），P = 0.005，在24小时时，WMD（95%CI）为-1.35（-2.03至-0.67），P < 0.001。
与吗啡相比，术中使用美沙酮可减轻术后疼痛。此外，美沙酮对术后疼痛的有益作用并非归因于术后阿片类药物消耗的增加。我们的结果表明，术中使用美沙酮可能是减轻手术患者急性疼痛的一种可行策略。
