Department of Surgery, St. Paul's Hospital & University of British Columbia, C303-1081 Burrard St, Vancouver, British Columbia, V6Z 1Y6, Canada.
Department of Anesthesia, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada.
Surg Oncol. 2022 May;41:101731. doi: 10.1016/j.suronc.2022.101731. Epub 2022 Feb 26.
This meta-analysis aimed to evaluate the body of evidence investigating the post-operative use of non-opioid analgesic drugs and techniques in endocrine neck surgeries. Adequate pain control is crucial for successful recovery after thyroid and parathyroid surgery. Effective postoperative pain control can shorten hospital stay, improve postoperative outcomes, decrease morbidity and improve the overall patient experience. Traditionally, opioids have been the mainstay of postoperative analgesia after thyroid and parathyroid surgeries. However, the use of opioids has been linked to an increased incidence of postoperative complications.
A comprehensive systematic literature review via Medline, Embase, Web of Science and Cochrane Central Register for Controlled Trials from inception until December 26th, 2020 was conducted, followed by meta-analysis. Abstract and full-text screening, data extraction and quality assessment were independently conducted by 2 investigators. Odds ratios (OR), mean differences (MD) and 95% confidence intervals were calculated using RevMan 5.3.
Sixty-five randomized control trials were identified from 486 unique publications. Pooled MD and 95% confidence interval for pain scores were higher for the control group at 24 h postoperatively both at rest (-0.65 [-0.92, -0.37]) and with swallowing (-0.77 [-1.37, -0.16]). These differences were statistically significant. The pooled MD and confidence interval for postoperative analgesic requirements was lower in the intervention group (-1.38 [-1.86, -0.90]). The incidence of PONV had a pooled OR of 0.67 [0.48, 0.94].
Non-opioid analgesia was superior to the control group for pain control in patients undergoing thyroid and parathyroid operations with no significant difference in complications.
本荟萃分析旨在评估内分泌颈部手术后使用非阿片类镇痛药和技术的证据。充分的疼痛控制对于甲状腺和甲状旁腺手术后的成功康复至关重要。有效的术后疼痛控制可以缩短住院时间、改善术后结局、降低发病率并改善整体患者体验。传统上，阿片类药物一直是甲状腺和甲状旁腺手术后的主要术后镇痛药物。然而，阿片类药物的使用与术后并发症的发生率增加有关。
通过 Medline、Embase、Web of Science 和 Cochrane 对照试验中心注册库进行了全面的系统文献综述，检索时间从成立到 2020 年 12 月 26 日，然后进行荟萃分析。两名研究者独立进行摘要和全文筛选、数据提取和质量评估。使用 RevMan 5.3 计算比值比 (OR)、均数差 (MD) 和 95%置信区间。
从 486 篇独特的出版物中确定了 65 项随机对照试验。在术后 24 小时，无论是在休息时（-0.65 [-0.92，-0.37]）还是吞咽时（-0.77 [-1.37，-0.16]），对照组的疼痛评分均较高，差异具有统计学意义。干预组术后镇痛需求的 MD 和置信区间较低（-1.38 [-1.86，-0.90]）。PONV 的发生率的合并 OR 为 0.67 [0.48, 0.94]。
非阿片类镇痛在甲状腺和甲状旁腺手术患者的疼痛控制方面优于对照组，且并发症无显著差异。
