Sun Li-Ying, Gitman Marina, Malik Ashish, Te Terry Pan Ling, Spiro Michael, Raptis Dimitri Aristotle, Ramsay Michael
Liver Transplantation Center & Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Department of Anesthesia Cleveland Clinic, Cleveland, Ohio, USA.
Clin Transplant. 2022 Oct;36(10):e14640. doi: 10.1111/ctr.14640.
Adequate pain control is essential for patients undergoing liver transplantation (LT). Multiple analgesic strategies have been implemented during the perioperative period. There is no consensus on the optimal perioperative analgesia management.
To provide recommendations, on the optimal perioperative analgesia management for LT.
Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central.
A systematic review and meta-analysis following PRISMA guidelines and recommendations using GRADE. Studies describing outcomes, morbidity, mortality, pain scores, intensive care unit and hospital length of stay in patients that received different pain management techniques during and after LT were included (CRD42021243282).
One thousand nine hundred ten articles were screened, but only two randomized controlled trials, one prospective and six retrospective studies were included. The opioid-avoidance protocols included, thoracic epidural analgesia (TEA), Transversus Abdominis Plane (TAP) block, as well as other non-opioid analgesics, resulted in improved short-term outcomes. Mortality was reduced in this group versus control cohorts (OR = 0.51; CI 0.14, 1.83; P = 0.350), Time to extubation, and intensive care unit LOS were shorter; pain scores after surgery were lower in opioid-avoidance group (percentage decrease, 35%, 12%, and 55%, respectively). However, hospital LOS was longer (percentage increase 8%).
Opioid-avoidance analgesia management for LT results in improved short-term outcomes. (Quality of Evidence; Moderate to low | Grade of Recommendation; Weak). Medications such as acetaminophen(paracetamol), gabapentin, ketamine, tramadol and local anesthesia may be used instead of, or as adjuncts to opioids for postoperative analgesia. Overall evidence remains weak and more robust studies are required.
对于接受肝移植（LT）的患者而言，充分的疼痛控制至关重要。围手术期已实施了多种镇痛策略。关于围手术期最佳镇痛管理尚无共识。
为肝移植围手术期最佳镇痛管理提供建议。
Ovid MEDLINE、Embase、Scopus、谷歌学术和Cochrane中心。
按照PRISMA指南和使用GRADE的建议进行系统评价和荟萃分析。纳入描述肝移植期间及术后接受不同疼痛管理技术的患者的结局、发病率、死亡率、疼痛评分、重症监护病房和住院时间的研究（CRD42021243282）。
共筛选出1910篇文章，但仅纳入两项随机对照试验、一项前瞻性研究和六项回顾性研究。避免使用阿片类药物的方案包括胸段硬膜外镇痛（TEA）、腹横肌平面（TAP）阻滞以及其他非阿片类镇痛药，这些方案改善了短期结局。与对照组相比，该组死亡率降低（OR = 0.51；CI 0.14，1.83；P = 0.350），拔管时间和重症监护病房住院时间缩短；避免使用阿片类药物组术后疼痛评分更低（分别降低35%、12%和55%）。然而，住院时间更长（增加8%）。
肝移植避免使用阿片类药物的镇痛管理可改善短期结局。（证据质量；中到低 | 推荐等级；弱）。对乙酰氨基酚（扑热息痛）、加巴喷丁、氯胺酮、曲马多和局部麻醉等药物可替代阿片类药物或作为其辅助药物用于术后镇痛。总体证据仍然薄弱，需要更有力的研究。
