Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan.
Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan; Department of Anesthesiology, College of Medicine, China Medical University, Taichung, Taiwan.
J Surg Res. 2024 Oct;302:814-824. doi: 10.1016/j.jss.2024.07.124. Epub 2024 Sep 5.
Diabetes mellitus (DM) is a prevalent metabolic disorder associated with various postoperative complications. The association between DM and postoperative opioid use remains unclear, with conflicting evidence in the literature. This systematic review and meta-analysis comprehensively evaluated the association between DM and postoperative opioid consumption, pain sensation, and adverse effects in surgical patients.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of electronic databases identified studies investigating the relationship between DM and postoperative pain outcomes. Eligible studies, both prospective and retrospective, were included based on the predefined criteria. Data extraction and quality assessment were performed independently by the authors. Meta-analyses were performed using Review Manager 5.
Among 100 initially identified articles, five studies met the inclusion criteria. In the meta-analysis, 473 participants were included. The results indicated that patients with DM had significantly higher postoperative opioid consumption (standardized mean difference, 0.79; 95% confidence interval, 0.26-1.31; P = 0.003) than those in the control group, with substantial heterogeneity (I = 83%). No significant differences in postoperative pain scale scores at rest or during movement were observed. Adverse effects, including nausea, vomiting, and pruritus, showed varied outcomes, whereas overall satisfaction did not differ between the two groups.
This meta-analysis provides evidence that patients with DM undergoing surgery consume more opioids postoperatively. Understanding the association between DM and pain management is crucial for optimizing perioperative care in this patient population.
糖尿病（DM）是一种常见的代谢紊乱疾病，与各种术后并发症有关。DM 与术后阿片类药物使用之间的关系尚不清楚，文献中存在相互矛盾的证据。本系统评价和荟萃分析全面评估了 DM 与手术患者术后阿片类药物消耗、疼痛感知和不良反应之间的关系。
根据系统评价和荟萃分析的首选报告项目指南，系统地搜索电子数据库，以确定研究 DM 与术后疼痛结果之间关系的研究。根据预设标准，纳入前瞻性和回顾性研究。作者独立进行数据提取和质量评估。使用 Review Manager 5 进行荟萃分析。
在最初确定的 100 篇文章中，有 5 篇符合纳入标准。荟萃分析中，纳入了 473 名参与者。结果表明，与对照组相比，DM 患者术后阿片类药物消耗明显更高（标准化均数差，0.79；95%置信区间，0.26-1.31；P=0.003），存在很大的异质性（I=83%）。在休息或运动时的术后疼痛量表评分方面没有显著差异。恶心、呕吐和瘙痒等不良反应的结果不同，而两组的总体满意度没有差异。
这项荟萃分析提供了证据表明，接受手术的 DM 患者术后阿片类药物消耗更多。了解 DM 和疼痛管理之间的关系对于优化该患者群体的围手术期护理至关重要。
