Muaddi Hala, Lillie Erin, Silva Stephanie, Cross Jori-Lee, Ladha Karim, Choi Stephen, Mocon Aaron, Karanicolas Paul
Department of Surgery, Division of General Surgery, University of Toronto, Toronto, ON, Canada.
Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Ann Surg. 2023 Feb 1;277(2):e257-e265. doi: 10.1097/SLA.0000000000004987. Epub 2023 Jan 10.
To systematically review and meta-analyze whether the application of cryotherapy on closed incisions reduces postoperative pain and opioid consumption.
Reduction of acute pain and opioid use is important in the postoperative phase of patient care. ''Cryotherapy'' refers to the use of low temperatures for therapeutic purposes.
MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Online registries of clinical trial were search until October 2019. RCT that examined postoperative application of cryotherapy over surgical incisions in adults compared to no cryotherapy were eligible. Selection, extraction, and risk of bias appraisal were completed in duplicate. Data were synthesized using random effects meta-analyses. The outcomes of interest were postoperative pain, opioid use, hospital length of stay (LOS) and surgical site infection (SSI).
Fifty-one RCTs (N = 3425 patients) were included. With moderate certainty evidence, patients treated with cryotherapy experienced a reduction in pain on postoperative day 1 (standardized mean differences -0.50, 95% CI -0.71 to -0.29, l 2= 74%) and day 2 (standardized mean differences -0.63, 95% CI -0.91 to -0.35, I 2 = 83%) relative to without cryotherapy application. With moderate certainty of evidence, cryotherapy reduces opioid consumption in morphine milliequivalents and morphine milliequivalents/kg, (mean differences -7.43, 95% CI -12.42, -2.44, I 2 = 96%) and (mean differences -0.89, 95% CI -1.45, -0.33, I 2 = 99%), respectively. With low certainty evidence, cryotherapy does not affect hospital LOS or rate of SSI.
Cryotherapy is a pragmatic, noncostly intervention that reduces postoperative pain and opioid consumption with no effect on SSI rate or hospital LOS.
系统评价并荟萃分析冷冻疗法应用于闭合切口是否能减轻术后疼痛及减少阿片类药物的使用量。
减轻急性疼痛和减少阿片类药物使用在患者术后护理阶段至关重要。“冷冻疗法”是指利用低温进行治疗。
检索MEDLINE、EMBASE、Cochrane对照试验中心注册库及临床试验在线注册库至2019年10月。纳入比较成人手术切口术后应用冷冻疗法与不应用冷冻疗法的随机对照试验。筛选、提取数据及偏倚风险评估由两人独立完成。采用随机效应荟萃分析对数据进行综合分析。感兴趣的结局指标为术后疼痛、阿片类药物使用、住院时间及手术部位感染。
纳入51项随机对照试验（N = 3425例患者）。基于中等确定性证据，与未应用冷冻疗法的患者相比，应用冷冻疗法的患者在术后第１天（标准化均数差 -0.50，95%CI -0.71至 -0.29，I² = 74%）和第2天（标准化均数差 -0.63，95%CI -0.91至 -0.35，I² = 83%）疼痛减轻。基于中等确定性证据，冷冻疗法分别使吗啡毫克当量及每千克体重吗啡毫克当量的阿片类药物使用量减少（均数差 -7.43，95%CI -12.42，-2.44，I² = 96%）和（均数差 -0.89，95%CI -1.45，-0.33，I² = 99%）。基于低确定性证据，冷冻疗法不影响住院时间或手术部位感染发生率。
冷冻疗法是一种实用、低成本的干预措施，可减轻术后疼痛并减少阿片类药物使用量，且对手术部位感染发生率及住院时间无影响。
