Department of Medicine - DIMED, Section of Anaesthesiology and Intensive Care, University of Padova, Padova, Italy; Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padova, Italy.
Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padova, Italy.
Br J Anaesth. 2024 Dec;133(6):1234-1249. doi: 10.1016/j.bja.2024.08.009. Epub 2024 Oct 3.
Managing postoperative pain in patients with obesity is challenging. Although multimodal analgesia has proved effective for pain relief, the specific impacts of different nonopioid i.v. analgesics and adjuvants on these patients are not well-defined. This study aims to assess the effectiveness of nonsteroidal antiinflammatory drugs, paracetamol, ketamine, α-2 adrenergic receptor agonists, lidocaine, magnesium, and oral gabapentinoids in reducing perioperative opioid consumption and, secondarily, in mitigating the occurrence of general and postoperative pulmonary complications (POPCs), nausea, vomiting, PACU length of stay (LOS), and hospital LOS among surgical patients with obesity.
A systematic review and network meta-analysis was performed. PubMed, Scopus, Web of Science, CINAHL, and EMBASE were searched. Only English-language RCTs investigating the use of nonopioid analgesics and adjuvants in adult surgical patients with obesity were included. The quality of evidence and certainty were assessed using the RoB 2 tool and GRADE framework, respectively.
In total, 37 RCTs involving 3602 patients were included in the quantitative analysis. Compared with placebo/no intervention or a comparator, dexmedetomidine, ketamine, lidocaine, magnesium, and gabapentin significantly reduced postoperative opioid consumption after surgery. Ketamine/esketamine also significantly reduced POPCs. Ibuprofen, dexmedetomidine, and lidocaine significantly reduced postoperative nausea, whereas dexmedetomidine, either alone or combined with pregabalin, and lidocaine reduced postoperative vomiting. Dexmedetomidine significantly reduced PACU LOS, whereas both paracetamol and lidocaine reduced hospital LOS.
Intravenous nonopioid analgesics and adjuvants are crucial in multimodal anaesthesia, reducing opioid consumption and enhancing postoperative care in adult surgical patients with obesity.
CRD42023399373 (PROSPERO).
肥胖患者术后疼痛的管理颇具挑战性。尽管多模式镇痛已被证实可有效缓解疼痛，但不同非阿片类静脉用镇痛药和辅助药物对这些患者的具体影响尚不清楚。本研究旨在评估非甾体抗炎药、对乙酰氨基酚、氯胺酮、α-2 肾上腺素能受体激动剂、利多卡因、镁和口服加巴喷丁类药物在减少围手术期阿片类药物消耗方面的有效性，其次是减轻肥胖手术患者的一般和术后肺部并发症（POPCs）、恶心、呕吐、PACU 住院时间（LOS）和总住院时间（LOS）的发生。
进行了系统评价和网络荟萃分析。检索了 PubMed、Scopus、Web of Science、CINAHL 和 EMBASE 数据库。仅纳入了使用非阿片类镇痛药和辅助药物治疗肥胖成年手术患者的英语 RCT。使用 RoB 2 工具和 GRADE 框架分别评估证据质量和确定性。
共纳入 37 项 RCT，涉及 3602 名患者，进行了定量分析。与安慰剂/无干预或对照相比，右美托咪定、氯胺酮、利多卡因、镁和加巴喷丁可显著减少术后阿片类药物的消耗。氯胺酮/ Esketamine 还可显著降低 POPCs。布洛芬、右美托咪定和利多卡因可显著减少术后恶心，而右美托咪定单独或与普瑞巴林联合使用以及利多卡因可减少术后呕吐。右美托咪定可显著缩短 PACU LOS，而对乙酰氨基酚和利多卡因可缩短总住院时间。
静脉内非阿片类镇痛药和辅助药物在多模式麻醉中至关重要，可减少肥胖成年手术患者的阿片类药物消耗并改善术后护理。
CRD42023399373（PROSPERO）。
