Nguyen Brandon K, Stathakios James, Quan Daniel, Pinto Jessica, Lin Hosheng, Pashkova Anna A, Svider Peter F
Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
Ann Otol Rhinol Laryngol. 2020 Oct;129(10):949-963. doi: 10.1177/0003489420919134. Epub 2020 May 21.
To perform an evidence-based systematic review evaluating perioperative analgesia, including opioid alternatives, used for patients undergoing thyroidectomy and parathyroidectomy.
A comprehensive literature search from 1997 to January 2018 of Pubmed, Cochrane, and EmBase libraries was performed for studies reporting analgesic administration following thyroid or parathyroid surgery. This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were evaluated for level of evidence and given a Jadad score to assess for risk of bias. Outcomes gathered included postoperative pain scores, time to rescue analgesia, rescue analgesic consumption, and adverse events.
Thirty-eight randomized controlled trials met inclusion criteria. The GRADE criteria determined the overall evidence to be moderate-high. Studies utilizing NSAIDs reported reduced requirements for rescue analgesics. Acetaminophen studies presented with conflicting data on effectiveness. Gabapentinoid studies demonstrated lower pain scores and an increased time to rescue analgesic. Local anesthetics were effective at decreasing Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) pain scores while also reducing rescue analgesic consumption. Ketamine was shown to increased postoperative nausea and vomiting. NSAIDs and local anesthetic studies had an aggregate grade of evidence A, while all others had grade B evidence.
There is significant evidence supporting the use of NSAIDs and local anesthetics in the perioperative period for pain management for thyroid and parathyroid surgeries. Acetaminophen, gabapentinoid and ketamine have some supporting evidence and may serve as adequate alternatives. Further multi-institutional RCTs are warranted to delineate optimal analgesic regimens.
NA.
进行一项基于证据的系统评价，评估用于甲状腺切除术和甲状旁腺切除术患者的围手术期镇痛，包括阿片类药物的替代方法。
对1997年至2018年1月期间Pubmed、Cochrane和EmBase数据库进行全面文献检索，以查找报告甲状腺或甲状旁腺手术后镇痛给药情况的研究。本系统评价基于系统评价和Meta分析的首选报告项目（PRISMA）指南。对研究进行证据水平评估，并给予Jadad评分以评估偏倚风险。收集的结果包括术后疼痛评分、补救镇痛时间、补救镇痛药消耗量和不良事件。
38项随机对照试验符合纳入标准。GRADE标准确定总体证据为中高等级。使用非甾体抗炎药（NSAIDs）的研究报告补救镇痛药需求量减少。对乙酰氨基酚的研究在有效性方面呈现出相互矛盾的数据。加巴喷丁类药物的研究显示疼痛评分较低且补救镇痛时间延长。局部麻醉药在降低视觉模拟评分（VAS）和数字评分量表（NRS）疼痛评分方面有效，同时还减少了补救镇痛药的消耗量。氯胺酮显示会增加术后恶心和呕吐。NSAIDs和局部麻醉药的研究证据等级为A，而其他所有研究的证据等级为B。
有大量证据支持在围手术期使用NSAIDs和局部麻醉药进行甲状腺和甲状旁腺手术的疼痛管理。对乙酰氨基酚、加巴喷丁类药物和氯胺酮有一些支持证据，可能是合适的替代药物。有必要进行进一步的多机构随机对照试验来确定最佳镇痛方案。
不适用。
