Sridharan Kannan, Sivaramakrishnan Gowri
Associate Professor, Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Manama, Bahrain.
Dental Specialist (Prosthodontist), Dental Training Department, Ministry of Health, Bahrain.
J Opioid Manag. 2020 Jul/Aug;16(4):267-275. doi: 10.5055/jom.2020.0580.
Vaso-occlusive crisis is the most common clinical feature requiring opioid analgesics in patients with sickle cell disease. We conducted a network meta-analysis to compare the drugs that can be used as add-on with opioids for vaso-occlusive crisis.
Network meta-analysis of randomized clinical trials.
Sickle cell disease patients with vaso-occlusive crisis receiving adjuvants to opioids for pain management.
A number of patients with complete pain relief and pain scores assessed either by visual ana-log or by a numerical rating scale were the primary outcomes. Adverse events and dose of opioids (in morphine equiva-lents) for pain alleviation between the treatment arms were the secondary outcome measures.
Eleven studies evaluating the addition of ketorolac, magnesium sulfate, ketoprofen, ibuprofen, methadone, inhalational nitric oxide, methylprednisolone, and arginine with morphine were obtained. The pooled analysis showed a favorable effect in the pain reduction for the additions of arginine {-2 [-3.39, -0.61]} and ibuprofen {-1.7 [-3.26, -0.14]} with morphine. Arginine has high probability of being the "best" in the pool followed by ibuprofen. No significant differ-ences were observed in the risk of adverse events {ketoprofen-0.84 [0.42, 1.65]; magnesium sulfate-1.81 [0.64, 5.81]; and arginine-2.08 [0.18, 24.31]}. A significant lower dose of opioid was required when given adjunctive to argin-ine, inhalational nitric oxide, and methylprednisolone.
We observed that arginine and ibuprofen could produce additional analgesic effects when combined with morphine in vaso-occlusive crisis.
血管闭塞性危象是镰状细胞病患者最常见的需要使用阿片类镇痛药的临床特征。我们进行了一项网状Meta分析，以比较可与阿片类药物联合用于血管闭塞性危象的药物。
随机临床试验的网状Meta分析。
患有血管闭塞性危象的镰状细胞病患者，接受阿片类药物辅助治疗以控制疼痛。
通过视觉模拟评分法或数字评分量表评估的完全疼痛缓解患者数量和疼痛评分是主要结局。各治疗组间用于缓解疼痛的阿片类药物不良事件和剂量（以吗啡当量计）是次要结局指标。
获得了11项评估酮咯酸、硫酸镁、酮洛芬、布洛芬、美沙酮、吸入一氧化氮、甲泼尼龙和精氨酸与吗啡联合使用的研究。汇总分析显示，精氨酸{-2 [-3.39, -0.61]}和布洛芬{-1.7 [-3.26, -0.14]}与吗啡联合使用在减轻疼痛方面有良好效果。精氨酸在组中最有可能是“最佳”药物，其次是布洛芬。在不良事件风险方面未观察到显著差异{酮洛芬-0.84 [0.42, 1.65]；硫酸镁-1.81 [0.64, 5.81]；精氨酸-2.08 [0.18, 24.31]}。当与精氨酸、吸入一氧化氮和甲泼尼龙联合使用时，所需的阿片类药物剂量显著较低。
我们观察到，在血管闭塞性危象中，精氨酸和布洛芬与吗啡联合使用时可产生额外的镇痛效果。
