Feenstra Minke L, Jansen Simone, Eshuis Wietse J, van Berge Henegouwen Mark I, Hollmann Markus W, Hermanides Jeroen
Department of Anesthesiology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC location University of Amsterdam, AGEM, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
Department of Anesthesiology, LUMC, Albinusdreef 2, Leiden, the Netherlands.
J Clin Anesth. 2023 Nov;90:111215. doi: 10.1016/j.jclinane.2023.111215. Epub 2023 Jul 27.
To evaluate all available evidence thus far on opioid based versus opioid-free anesthesia and its effect on acute and chronic postoperative pain.
Systematic review and meta-analysis of randomized clinical trials.
Operating room, postoperative recovery room and ward.
Patients undergoing general anesthesia.
After consulting MEDLINE, EMBASE and Cochrane database, studies which compared opioid free anesthesia (OFA) with opioid based anesthesia (OBA) were included (last search April 15th 2022).
Primary outcomes were acute and chronic pain scores in NRS or VAS. Secondary outcomes were quality of recovery and postoperative opioid consumption. Risk of bias was assessed using the RoB2 tool and a random effects model for the meta-analysis was conducted.
We identified 1245 citations, of which 38 studies met our inclusion criteria. There is moderate quality evidence showing no clinically relevant difference of Numeric Rating Scale (NRS) scores or opioid consumption in the postoperative period (pooled mean difference of 0.39 points with a CI of 0.19-0.59 and 4.02 MME with a CI of 1.73-6.30). We found only one small-sized study reporting no effect of opioid-free anesthesia on chronic pain. The quality of recovery was superior in patients with opioid-free anesthesia (mean difference of 8.26 points), however, this pooled analysis was comprised of only two studies. Postoperative nausea and vomiting (PONV) occurred less in opioid-free anesthesia, but bradycardia was more frequent.
We concluded that we cannot recommend one strategy over the other. Future studies could focus on quality of recovery as outcome measure and adequately powered studies on the effects of opioid-free anesthesia on chronic pain are eagerly awaited.
评估迄今为止关于阿片类药物麻醉与非阿片类药物麻醉及其对术后急性和慢性疼痛影响的所有现有证据。
对随机临床试验进行系统评价和荟萃分析。
手术室、术后恢复室和病房。
接受全身麻醉的患者。
在查阅MEDLINE、EMBASE和Cochrane数据库后，纳入比较非阿片类药物麻醉（OFA）与阿片类药物麻醉（OBA）的研究（最后一次检索时间为2022年4月15日）。
主要结局为数字评分量表（NRS）或视觉模拟量表（VAS）中的急性和慢性疼痛评分。次要结局为恢复质量和术后阿片类药物消耗量。使用RoB2工具评估偏倚风险，并进行荟萃分析的随机效应模型。
我们识别出1245条文献，其中38项研究符合我们的纳入标准。有中等质量的证据表明，术后数字评分量表（NRS）评分或阿片类药物消耗量无临床相关差异（合并平均差异为0.39分，置信区间为0.19 - 0.59；4.02毫克吗啡当量，置信区间为1.73 - 6.30）。我们仅发现一项小型研究报告非阿片类药物麻醉对慢性疼痛无影响。非阿片类药物麻醉患者的恢复质量更佳（平均差异为8.26分），然而，该汇总分析仅包含两项研究。非阿片类药物麻醉术后恶心呕吐（PONV）发生率较低，但心动过缓更常见。
我们得出结论，无法推荐一种策略优于另一种策略。未来的研究可以将恢复质量作为结局指标，并且迫切期待有足够样本量的研究来探讨非阿片类药物麻醉对慢性疼痛的影响。
