比较羟考酮和舒芬太尼用于术后患者患者自控静脉镇痛的效果：一项随机对照试验的荟萃分析。

Comparison of oxycodone and sufentanil in patient-controlled intravenous analgesia for postoperative patients: a meta-analysis of randomized controlled trials.

机构信息

Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.

Department of Anesthesiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China.

出版信息

Chin Med J (Engl). 2023 Jan 5;136(1):45-52. doi: 10.1097/CM9.0000000000002259.

DOI:10.1097/CM9.0000000000002259

PMID:36878002

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10106226/

Abstract

BACKGROUND

Managing acute postoperative pain is challenging for anesthesiologists, surgeons, and patients, leading to adverse events despite making significant progress. Patient-controlled intravenous analgesia (PCIA) is a recommended solution, where oxycodone has depicted unique advantages in recent years. However, controversy still exists in clinical practice and this study aimed to compare two drugs in PCIA.

METHODS

We performed a literature search in PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, Chinese National Knowledge Infrastructure, Wanfang, and VIP databases up to December 2020 to select specific randomized controlled trials (RCTs) comparing the efficacy of oxycodone with sufentanil in PCIA. The analgesic effect was the primary outcome and the secondary outcome included PCIA consumption, the Ramsay sedation scale, patients' satisfaction and side effects.

RESULTS

Fifteen RCTs were included in the meta-analysis. Compared with sufentanil, oxycodone showed lower Numerical Rating Scale scores (mean difference [MD] = -0.71, 95% confidence interval [CI]: -1.01 to -0.41; P < 0.001; I2 = 93%), demonstrated better relief from visceral pain (MD = -1.22, 95% CI: -1.58 to -0.85; P < 0.001; I2 = 90%), promoted a deeper sedative level as confirmed by the Ramsay Score (MD = 0.77, 95% CI: 0.35-1.19; P < 0.001; I2 = 97%), and resulted in fewer side effects (odds ratio [OR] = 0.46, 95% CI: 0.35-0.60; P < 0.001; I2 = 11%). There was no statistical difference in the degree of patients' satisfaction (OR = 1.13, 95% CI: 0.88-1.44; P = 0.33; I2 = 72%) and drug consumption (MD = -5.55, 95% CI: -14.18 to 3.08; P = 0.21; I2 = 93%).

CONCLUSION

Oxycodone improves postoperative analgesia and causes fewer adverse effects, and could be recommended for PCIA, especially after abdominal surgeries.

REGISTRATION

PROSPERO; https://www.crd.york.ac.uk/PROSPERO/; CRD42021229973.

摘要

背景

管理急性术后疼痛对麻醉师、外科医生和患者来说都是一项挑战，尽管已经取得了重大进展，但仍会导致不良事件。患者自控静脉镇痛（PCIA）是一种推荐的解决方案，近年来，羟考酮在其中显示出了独特的优势。然而，在临床实践中仍存在争议，本研究旨在比较两种药物在 PCIA 中的应用。

方法

我们在 PubMed、Embase、Cochrane 对照试验中心注册库、Web of Science、中国国家知识基础设施（CNKI）、万方和 VIP 数据库中进行了文献检索，检索时间截至 2020 年 12 月，以选择比较羟考酮和舒芬太尼在 PCIA 中疗效的特定随机对照试验（RCT）。镇痛效果为主要结局，次要结局包括 PCIA 消耗、Ramsay 镇静评分、患者满意度和副作用。

结果

纳入的 15 项 RCT 进行了荟萃分析。与舒芬太尼相比，羟考酮的数字评分量表（NRS）评分较低（均数差[MD] = -0.71，95%置信区间[CI]：-1.01 至 -0.41；P < 0.001；I2 = 93%），内脏疼痛缓解效果更好（MD = -1.22，95%CI：-1.58 至 -0.85；P < 0.001；I2 = 90%），Ramsay 评分证实镇静程度更深（MD = 0.77，95%CI：0.35 至 1.19；P < 0.001；I2 = 97%），且副作用更少（比值比[OR] = 0.46，95%CI：0.35 至 0.60；P < 0.001；I2 = 11%）。患者满意度（OR = 1.13，95%CI：0.88 至 1.44；P = 0.33；I2 = 72%）和药物消耗（MD = -5.55，95%CI：-14.18 至 3.08；P = 0.21；I2 = 93%）方面无统计学差异。