全身麻醉中阿片类药物滴定的伤害性感受监测与标准实践：一项随机对照试验的荟萃分析

Nociception monitors vs. standard practice for titration of opioid administration in general anesthesia: A meta-analysis of randomized controlled trials.

作者信息

Ma Dandan, Ma Jiahui, Chen Huayong, Mu Dongliang, Kong Hao, Yu Lingzhi

机构信息

Department of Pain Management, Jinan Central Hospital, Shandong University, Jinan, China.

Department of Anesthesiology, Yidu Central Hospital Affiliated to Weifang Medical University, Weifang, China.

出版信息

Front Med (Lausanne). 2022 Aug 25;9:963185. doi: 10.3389/fmed.2022.963185. eCollection 2022.

DOI:10.3389/fmed.2022.963185

PMID:36091708

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9454957/

Abstract

BACKGROUND

Nociception monitors are being increasingly used during surgery, but their effectiveness in guiding intraoperative opioid administration is still uncertain. This meta-analysis of randomized controlled trials (RCTs) aimed to compare the effectiveness of nociception monitors vs. standard practice for opioid administration titration during general anesthesia.

METHODS

We searched the electronic databases of PubMed, EMBASE, Cochrane Library, Clinical Trial, and Web of Science from inception up to August 1, 2021, to identify relevant articles, and extracted the relevant data. Intraoperative opioid administration, extubation time, postoperative pain score, postoperative opioid consumption and postoperative nausea and vomiting (PONV) were compared between patients receiving nociception monitoring guidance and patients receiving standard management. The standardized mean difference (SMD), with 95% confidence interval (CI), was used to assess the significance of differences. The risk ratio (RR), with 95% CI, was used to assess the difference in incidence of PONV. Heterogeneity among the included trials was evaluated by the test. RevMan 5.3 software was used for statistical analysis.

RESULTS

A total of 21 RCTs (with 1957 patients) were included in the meta-analysis. Intraoperative opioid administration was significantly lower in patients receiving nociception monitor-guided analgesia than in patients receiving standard management (SMD, -0.71; 95% CI, -1.07 to -0.36; < 0.001). However, pain scores and postoperative opioid consumption were not significantly higher in the former group. Considerable heterogeneity was found among the studies (92%). Extubation time was significantly shorter (SMD, -0.22; 95% CI, -0.41 to -0.03; = 0.02) and the incidence of PONV significantly lower (RR, 0.78; 95% CI, 0.61 to 1.00; = 0.05) in patients receiving nociception monitoring guidance.

CONCLUSIONS

Intraoperative nociception monitoring guidance may reduce intraoperative opioid administration and appears to be a viable strategy for intraoperative titration of opioids.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=273619, identifier: CRD42019129776.

摘要

背景

伤害感受监测器在手术期间的使用越来越多，但其在指导术中阿片类药物给药方面的有效性仍不确定。这项随机对照试验（RCT）的荟萃分析旨在比较伤害感受监测器与全身麻醉期间阿片类药物滴定的标准做法的有效性。

方法

我们检索了PubMed、EMBASE、Cochrane图书馆、临床试验和Web of Science的电子数据库，从创建到2021年8月1日，以识别相关文章，并提取相关数据。比较接受伤害感受监测指导的患者和接受标准管理的患者的术中阿片类药物给药、拔管时间、术后疼痛评分、术后阿片类药物消耗量和术后恶心呕吐（PONV）。采用标准化均数差（SMD）及95%置信区间（CI）评估差异的显著性。采用风险比（RR）及95%CI评估PONV发生率的差异。通过检验评估纳入试验之间的异质性。使用RevMan 5.3软件进行统计分析。

结果

荟萃分析共纳入21项RCT（1957例患者）。接受伤害感受监测引导镇痛的患者术中阿片类药物给药显著低于接受标准管理的患者（SMD，-0.71；95%CI，-1.07至-0.36； < 0.001）。然而，前一组的疼痛评分和术后阿片类药物消耗量并没有显著更高。研究之间存在相当大的异质性（92%）。接受伤害感受监测指导的患者拔管时间显著缩短（SMD，-0.22；95%CI，-0.41至-0.03； = 0.02），PONV发生率显著降低（RR，0.78；95%CI，0.61至1.00； = 0.05）。