鼻腔内给予氯胺酮治疗成人急性疼痛的疗效：系统评价和荟萃分析。
Efficacy of intranasal ketamine for acute pain management in adults: a systematic review and meta-analysis.
机构信息
Department of Pharmacy, Zaozhuang Municipal Hospital, Zaozhuang, Shandong Province, P.R. China.
出版信息
Eur Rev Med Pharmacol Sci. 2021 Apr;25(8):3286-3295. doi: 10.26355/eurrev_202104_25738.
OBJECTIVE
This study aimed to compare the efficacy of intranasal (IN) ketamine for pain control with placebo and other analgesics in an emergency setting.
MATERIALS AND METHODS
Electronic databases of PubMed, Embase, and CENTRAL were searched for randomized controlled trials (RCTs) comparing IN ketamine with placebo or other analgesics up to 1st January 2021. Studies were to be conducted on adults and in an emergency setting. Pain outcomes and adverse events were compared.
RESULTS
Seven RCTs were included. Three compared IN ketamine with placebo while others with opioids. Comparing IN ketamine with opioids, the pooled analysis demonstrated no significant difference in pain scores between the two groups at 15 minutes but better pain reduction with opioids at 30 minutes. Comparing IN ketamine with placebo, our analysis demonstrated a non-significant difference but a tendency for better pain relief with IN ketamine at 15 minutes and 60 minutes. Pain scores at 30 minutes were, however, significantly lower with IN ketamine as compared to placebo. The need for rescue analgesics was significantly lower with IN ketamine as compared to placebo. There was no significant difference in the incidence of dizziness and nausea/vomiting between IN ketamine and opioids. As compared to placebo, IN ketamine was associated with an increased incidence of dizziness but not nausea/vomiting. Emergence reactions were significantly increased with IN ketamine as compared to opioids and placebo.
CONCLUSIONS
There may be a role of IN ketamine for acute pain management in adults in an emergency setting. There is a tendency for better pain control with IN ketamine as compared to control and the possibility of similar efficacy of IN ketamine as compared to opioids. However, the results are not unequivocal and are limited by the low number of studies in literature and limited pain indications studied. Further RCTs are required to strengthen the evidence.
目的
本研究旨在比较鼻内（IN）氯胺酮在急诊环境中控制疼痛的疗效与安慰剂和其他镇痛药的疗效。
材料和方法
检索了 PubMed、Embase 和 CENTRAL 的电子数据库，以查找截至 2021 年 1 月 1 日比较 IN 氯胺酮与安慰剂或其他镇痛药的随机对照试验（RCT）。研究对象为成年人，且在急诊环境中进行。比较了疼痛结局和不良反应。
结果
纳入了 7 项 RCT。其中 3 项比较了 IN 氯胺酮与安慰剂，其他与阿片类药物比较。与阿片类药物相比，荟萃分析显示两组在 15 分钟时疼痛评分无显著差异，但 30 分钟时阿片类药物的疼痛缓解效果更好。与安慰剂相比，我们的分析显示 IN 氯胺酮在 15 分钟和 60 分钟时的疼痛缓解效果无显著差异，但有倾向更好。然而，30 分钟时 IN 氯胺酮的疼痛评分显著低于安慰剂。与安慰剂相比，IN 氯胺酮的解救性镇痛需求显著降低。IN 氯胺酮与阿片类药物相比，头晕和恶心/呕吐的发生率无显著差异。与安慰剂相比，IN 氯胺酮与头晕的发生率增加有关，但与恶心/呕吐无关。与阿片类药物和安慰剂相比，IN 氯胺酮的出现反应明显增加。
结论
IN 氯胺酮可能在急诊环境中用于成人急性疼痛管理。与对照相比，IN 氯胺酮有控制疼痛的趋势，与阿片类药物相比，IN 氯胺酮可能具有相似的疗效。然而，结果并不明确，且受文献中研究数量有限和研究疼痛适应证有限的限制。需要进一步的 RCT 来加强证据。
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