Comparan Hector David Meza, Khaliq Anum, Frota Luciola Martins, Pomar-Forero Daniela, Ahmad Bakhtawar, Marnet Erica, Teixeira Fernanda J P, Thomas Anita, Patel Priyank, Brunkal Haley, Singireddy Saanvi, Lucke-Wold Brandon, Maciel Carolina B, Busl Katharina M
Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA.
Department of Medicine, Bridgeport Hospital, Bridgeport, CT, 06610, USA.
Neurocrit Care. 2025 Apr;42(2):680-689. doi: 10.1007/s12028-024-02114-y. Epub 2024 Sep 12.
Headache management after acute brain injury (ABI) is challenging. Although opioids are commonly used, selective cyclooxygenase 2 inhibitors (COXIBs) may be promising alternatives. However, concerns about cardiovascular effects and bleeding risk have limited their use. We aimed at summarizing available data on efficacy of COXIBs for headache management following ABI. A systematic review was conducted through MEDLINE and Embase for articles published through September 2023 (PROSPERO identifier: CRD42022320453). No language filters were applied to the initial searches. Interventional or observational studies and systematic reviews assessing efficacy of COXIBs for headache in adults with ABI were eligible. Article selection was performed by two independent reviewers using DistillerSR. Descriptive statistics were used for data analysis, and meta-analysis was unfeasible because of study heterogeneity. Of 3190 articles identified, 6 studies met inclusion criteria: 4 randomized controlled trials and 2 retrospective cohort studies, all conducted in elective cranial neurosurgical patients (total N = 738) between 2006 and 2022. Five studies used COXIBs in the intervention group only. Of the six studies, four found a reduction in overall pain scores in the intervention group, whereas one showed improvement only at 6 h postoperatively, and one did not find significant differences. Pain scores decreased between 4 and 15%, the largest shift being from moderate to mild severity. Three studies found an overall opioid use reduction throughout hospitalization in the intervention group, whereas one reported a reduction at 12 h postoperatively only. Opioid consumption decreased between 9 and 90%. Two studies found a decrease in hospital length of stay by ~ 1 day in the intervention group. The one study reporting postoperative hemorrhage found a statistically nonsignificant 3% reduction in the intervention group. COXIBs may serve as opioid-sparing adjunctive analgesics for headache control after elective cranial surgery. Limited or no literature exists for other forms of ABI, and additional safety data remain to be elucidated.
急性脑损伤（ABI）后的头痛管理具有挑战性。尽管阿片类药物常用，但选择性环氧化酶2抑制剂（COXIBs）可能是有前景的替代药物。然而，对心血管效应和出血风险的担忧限制了它们的使用。我们旨在总结关于COXIBs用于ABI后头痛管理疗效的现有数据。通过MEDLINE和Embase对截至2023年9月发表的文章进行了系统综述（PROSPERO标识符：CRD42022320453）。初始检索未应用语言过滤器。评估COXIBs对ABI成年患者头痛疗效的干预性或观察性研究及系统综述符合要求。由两名独立评审员使用DistillerSR进行文章筛选。采用描述性统计进行数据分析，由于研究异质性，无法进行荟萃分析。在识别出的3190篇文章中，6项研究符合纳入标准：4项随机对照试验和2项回顾性队列研究，均在2006年至2022年期间对择期颅脑神经外科患者进行（总样本量N = 738）。5项研究仅在干预组使用COXIBs。在这6项研究中，4项发现干预组总体疼痛评分降低，而1项仅在术后6小时显示改善，1项未发现显著差异。疼痛评分下降了4%至15%，最大变化是从中度严重程度降至轻度严重程度。3项研究发现干预组在整个住院期间总体阿片类药物使用减少，而1项仅报告术后12小时减少。阿片类药物消耗量下降了9%至90%。2项研究发现干预组住院时间缩短约1天。报告术后出血的1项研究发现干预组有3%的降低，但无统计学意义。COXIBs可作为择期颅脑手术后控制头痛的阿片类药物节省辅助镇痛药。对于其他形式的ABI，相关文献有限或不存在，仍有待阐明更多安全性数据。
