Department of Emergency Medicine, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia.
Department, King Fahad University Hospital, Al Khobar, Saudi Arabia.
Med Arch. 2023;77(4):281-287. doi: 10.5455/medarh.2023.77.281-287.
Most patients with acute pancreatitis (AP) suffer from abdominal pain that requires immediate pain relief, and there are various medication choices available, with opioids being the most prescribed analgesics.
Our objective is to compare the use of opioids with other medications in emergency settings for managing pain in patients with AP.
A systemic search was conducted in electronic databases (PubMed/Medline, Cochrane Library, Embase and Google Scholar) from inception to Feb 2023. All statistical analyses were conducted in Review Manager 5.4.1. The study's inclusion criteria was then selected. Only those Randomized Controlled Trials were involved that included patients having AP in an emergency setting. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported in the Odds Ratio (OR) and Mean Difference (MD) along with the corresponding 95% confidence interval (CI). Narrative analysis was conducted for those variables which did not have sufficient data be included in the quantitative analysis.
We include eight Randomized Controlled Trials in our study. The Pooled result showed non-significant differences in adverse effects between the two interventions (OR 1.42 [95% CI 0.62, 3.23]; p value= 0.40; I2= 20%). While overall, significantly additional drugs were used in the control group (OR 0.22 [95% CI 0.06, 0.85]; p value= 0.03; I2= 72%). Pain score and severity levels were also analyzed. We used a narrative approach to analyze the length of stay, mean time to reach significant decrease in pain, and mortality, which were all non-conclusive. We also narratively assessed the Pediatric population.
Opioids do not provide significant superiority over other medications and should be avoided due to their addictive nature.
大多数急性胰腺炎（AP）患者都有腹痛，需要立即缓解疼痛，有多种药物可供选择，其中阿片类药物是最常用的镇痛药。
我们旨在比较阿片类药物与其他药物在急诊环境中治疗 AP 患者疼痛的效果。
从建库起至 2023 年 2 月，我们在电子数据库（PubMed/Medline、Cochrane 图书馆、Embase 和 Google Scholar）中进行了系统性检索。所有统计分析均在 Review Manager 5.4.1 中进行。然后选择研究的纳入标准。仅纳入在急诊环境中患有 AP 的患者的随机对照试验。当存在异质性时，使用随机效应模型对研究进行合并，并以比值比（OR）和均数差（MD）以及相应的 95%置信区间（CI）报告结果。对于那些没有足够数据进行定量分析的变量，进行了叙述性分析。
我们的研究纳入了 8 项随机对照试验。汇总结果显示，两种干预措施的不良反应无显著差异（OR 1.42 [95% CI 0.62, 3.23]；p 值=0.40；I2=20%）。虽然总体而言，对照组中使用的附加药物明显更多（OR 0.22 [95% CI 0.06, 0.85]；p 值=0.03；I2=72%）。我们还分析了疼痛评分和严重程度。我们采用叙述性方法分析了住院时间、疼痛明显缓解的平均时间和死亡率，这些结果均无定论。我们还对儿科人群进行了叙述性评估。
由于阿片类药物具有成瘾性，因此它们并不比其他药物具有显著优势，应避免使用。
