Doleman Brett, Johnson Síle Ann, Last Daniel, Ali Nuriyah, Klezl Zdenek, Rogerson David, Lund Jonathan, Williams John
Department of Anaesthetics, Royal Derby Hospital, Derby, United Kingdom; Anaesthesia, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom.
Department of Anaesthetics, Royal Derby Hospital, Derby, United Kingdom; Anaesthesia, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom.
J Perianesth Nurs. 2025 Apr;40(2):415-421.e4. doi: 10.1016/j.jopan.2024.04.005. Epub 2024 Aug 15.
Postoperative pain is a common consequence of surgery. Pre-emptive analgesia involves the initiation of analgesics prior to surgical incision. This has been proposed as a simple method to help reduce postoperative pain, which may be more effective in higher-risk populations such as cervical spine surgery. A previous meta-analysis has demonstrated that pre-emptive acetaminophen may be effective in reducing postoperative pain although the certainty of evidence was limited. This present paper is an updated meta-analysis comparing pre-emptive acetaminophen versus postincision acetaminophen in adult patients undergoing surgery.
Systematic review and meta-analysis with the inclusion of an unpublished randomized, placebo-controlled, double-blind trial.
An updated meta-analysis was conducted which searched electronic databases to identify randomized controlled trials with the same interventions.
We included 845 participants and 12 studies in the updated meta-analysis. The meta-analysis (including our trial) found reduced 24-hour morphine consumption in the pre-emptive group (mean difference -2.42 mg; 95% confidence interval -4.26 to -0.59 mg), as well as reduced postoperative vomiting (risk ratio 0.56; 95% confidence interval 0.36 to 0.88). There was no difference between pre-emptive acetaminophen and control groups for time to analgesic request, pain scores at 6 and 24 hours or pruritis. For all outcomes assessed, there was very low certainty of evidence.
This meta-analysis found pre-emptive acetaminophen reduced 24-hour opioid consumption and postoperative vomiting.
术后疼痛是手术常见的后果。超前镇痛是指在手术切口前开始使用镇痛药。这被认为是一种有助于减轻术后疼痛的简单方法，在诸如颈椎手术等高风险人群中可能更有效。先前的一项荟萃分析表明，超前使用对乙酰氨基酚可能有助于减轻术后疼痛，尽管证据的确定性有限。本文是一项更新的荟萃分析，比较了成年手术患者中超前使用对乙酰氨基酚与切口后使用对乙酰氨基酚的效果。
系统评价和荟萃分析，纳入一项未发表的随机、安慰剂对照、双盲试验。
进行了一项更新的荟萃分析，检索电子数据库以识别采用相同干预措施的随机对照试验。
在更新的荟萃分析中，我们纳入了845名参与者和12项研究。荟萃分析（包括我们的试验）发现，超前用药组24小时吗啡用量减少（平均差值 -2.42 mg；95%置信区间 -4.26至 -0.59 mg），术后呕吐也减少（风险比0.56；95%置信区间0.36至0.88）。超前使用对乙酰氨基酚组与对照组在镇痛需求时间、6小时和24小时疼痛评分或瘙痒方面没有差异。对于所有评估的结局，证据的确定性都非常低。
这项荟萃分析发现，超前使用对乙酰氨基酚可减少24小时阿片类药物用量和术后呕吐。
