预先使用对乙酰氨基酚对阿片类药物消耗的影响：一项荟萃分析。

Effect of Preemptive Acetaminophen on Opioid Consumption: A Meta-Analysis.

机构信息

Department of Anesthesia, The First Hospital of Jilin University, Jilin, China.

Department of Anesthesia, The Second Hospital of Jilin University, Jilin, China.

出版信息

Pain Physician. 2021 Mar;24(2):E153-E160.

PMID:33740343

Abstract

BACKGROUND

Strategies for reducing postoperative opioid consumption have been explored in many recent studies, due in large part to the recent opioid epidemic. Preemptive analgesia has been proposed as a potential method, but its use is still controversial.

OBJECTIVES

This review aimed to evaluate the efficacy of a single dose of acetaminophen as preemptive analgesia for patients undergoing general anesthesia.

STUDY DESIGN

A meta-analysis of randomized controlled trials (RCTs).

SETTING

The electronic databases of PubMed, EMBASE, Cochrane Library, and the Web of Science were searched. The protocol was previously registered in the PROSPERO database under the registration number CRD 42020165634.

METHODS

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. RCTs that compared preemptive acetaminophen with placebo in surgical patients receiving general anesthesia were included. The risk of bias for each included study was independently assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions.

RESULTS

Six studies with 563 patients were included. Overall, the studies showed a reduction in 24-hour opioid consumption (standardized mean difference [SMD], -1.45; 95% confidence interval [CI], -2.36 to -0.55; P = 0.002), pain scores at 12 hours postoperatively (SMD, -0.86; 95% CI, -1.25 to -0.48; P < 0.0001), and a lower incidence of postoperative nausea (risk ratio [RR] 0.45; 95% CI, 0.34-0.58; P < 0.001) and vomiting (RR 0.39; 95% CI, 0.22-0.72; P = 0.002).

LIMITATIONS

The major limitation of this meta-analysis relates to the risk of bias in the limited number of included studies.

CONCLUSIONS

Preemptive acetaminophen administration significantly reduces opioid consumption within the initial 24 hours following general anesthesia, with lower pain scores at 12 hours after surgery, and less nausea and vomiting. However, well-conducted RCTs are still needed.

摘要

背景

由于近期阿片类药物泛滥，许多近期的研究都探讨了减少术后阿片类药物使用的策略。预先镇痛已被提出作为一种潜在的方法，但它的使用仍存在争议。

目的

本综述旨在评估单次剂量对乙酰氨基酚作为全身麻醉患者预先镇痛的效果。

研究设计

一项随机对照试验（RCT）的荟萃分析。

设置

检索了 PubMed、EMBASE、Cochrane 图书馆和 Web of Science 的电子数据库。该方案已在 PROSPERO 数据库中按照系统评价和荟萃分析的首选报告项目（PRISMA）声明进行了预先注册，注册号为 CRD42020165634。

方法

我们遵循了系统评价和荟萃分析的首选报告项目（PRISMA）声明。纳入了比较全身麻醉手术患者使用预先对乙酰氨基酚与安慰剂的 RCT。使用 Cochrane 干预系统评价手册中列出的标准独立评估每个纳入研究的偏倚风险。

结果

纳入了 6 项研究共 563 名患者。总体而言，这些研究显示 24 小时内阿片类药物的使用量减少（标准化均数差[SMD]，-1.45；95%置信区间[CI]，-2.36 至 -0.55；P=0.002）、术后 12 小时疼痛评分降低（SMD，-0.86；95%CI，-1.25 至 -0.48；P<0.0001）以及术后恶心（风险比[RR]，0.45；95%CI，0.34-0.58；P<0.001）和呕吐（RR，0.39；95%CI，0.22-0.72；P=0.002）的发生率降低。