University of Aberdeen School of Medicine, Medical Sciences and Nutrition, Aberdeen, Scotland, UK.
NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK.
BMC Anesthesiol. 2023 Aug 30;23(1):294. doi: 10.1186/s12871-023-02243-5.
National guidelines for rational opioid prescribing for acute postoperative pain are needed to optimise postoperative pain control and function whilst minimising opioid-related harm.
This overview of systematic reviews aims to summarise and critically assess the quality of systematic reviews related to the 20 recommendations from two previously published consensus guideline papers (ten relevant at patient and prescriber levels and ten at a system / Public Health level). It also aims to identify gaps in research that require further efforts to fill these in order to augment the evidence behind creating national guidelines for rational opioid prescribing for acute postoperative pain.
A systematic database search using PubMed/MEDLINE and Cochrane was conducted in November 2022. Furthermore, reference lists were reviewed. All identified systematic reviews were assessed for eligibility. Data from each study was extracted using a pre-standardised data extraction form. The methodological quality of the included reviews was assessed by two independent reviewers using the AMSTAR 2 checklist. Descriptive synthesis of the results was performed.
A total of 12 papers were eligible for analysis. Only eight out of the total 20 prioritised recommendations had systematic reviews that provided evidence related to them. These systematic reviews were most commonly of critically low quality.
The consensus papers provide guidance and recommendations based on the consensus of expert opinion that is based on the best available evidence. However, there is a lack of evidence supporting many of these consensus statements. Efforts to further analyse interventions that aim to reduce the rates of opioid prescribing and their adverse effects should therefore continue.
需要制定国家合理使用阿片类药物治疗急性术后疼痛的指南，以优化术后疼痛控制和功能，同时最大限度地减少阿片类药物相关的危害。
本系统评价综述旨在总结和批判性评估与之前发表的两份共识指南文件（其中 10 项与患者和处方医生相关，10 项与系统/公共卫生相关）中 20 项建议相关的系统评价的质量。它还旨在确定研究中的差距，需要进一步努力填补这些差距，以增加制定国家合理使用阿片类药物治疗急性术后疼痛指南的证据。
2022 年 11 月，使用 PubMed/MEDLINE 和 Cochrane 进行了系统的数据库搜索。此外，还审查了参考文献列表。对所有确定的系统评价进行了资格评估。使用预先标准化的数据提取表提取每个研究的数据。两名独立评审员使用 AMSTAR 2 清单评估纳入综述的方法学质量。对结果进行描述性综合。
共有 12 篇论文符合分析条件。只有 20 项优先建议中的 8 项有提供相关证据的系统评价。这些系统评价通常质量极低。
共识文件提供了基于专家共识的指导和建议，这些共识是基于最佳现有证据。然而，许多共识声明缺乏证据支持。因此，应继续努力进一步分析旨在降低阿片类药物处方率及其不良反应的干预措施。
