Reinert Justin P, Lee-Smith Wade, Jerousek Cole
The University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, OH, USA.
The University of Toledo Libraries, Toledo, OH, USA.
J Pharm Technol. 2024 Dec;40(6):287-295. doi: 10.1177/87551225241277450. Epub 2024 Sep 8.
To evaluate the safety of utilizing multimodal analgesic regimens in critically ill, nonintubated patients. Data Sources: A systematic review was conducted using Embase, MEDLINE, Cochrane, SciELO, Web of Science, and the Korean Journal Index. Clinical trials of critically ill, nonintubated patients that contained complete safety outcomes date, including the incidence of specific adverse drug effects (ADE) associated with a multimodal analgesic medication or regimen, were included. The primary outcome was the incidence of adverse drug effects associated with multimodal analgesics in comparison to standard-of-care analgesic strategies in our patient population. The secondary outcome was a subgroup analysis of adverse drug effect by type and by medication. 10 trials were included in this systematic review, of which 6 were randomized control trials that were evaluated in the meta-analysis. There was no statistically significant difference with respect to the primary outcome (mean difference = -0.11, = 0.31, 95% CI = [-0.35, 0.13]). The subgroup analysis, which was conducted on randomized clinical control trials that documented a single adjunctive analgesic rather than a multimodal regimen, was stratified by the type of adverse effect encountered and the medication in question. There were no statistically significant findings regarding the incidence of specific ADE. Nonrandomized data included in this study support these findings. Conclusions: While concerns of the additive deleterious adverse effects commonly encountered in polypharmacy are valid, our findings support the use of multimodal analgesic regimens in the provision of analgesic in critically ill, nonintubated patients.
评估在重症非插管患者中使用多模式镇痛方案的安全性。数据来源：使用Embase、MEDLINE、Cochrane、SciELO、Web of Science和韩国期刊索引进行了系统评价。纳入了包含完整安全性结果数据的重症非插管患者临床试验，包括与多模式镇痛药物或方案相关的特定药物不良反应（ADE）发生率。主要结局是与多模式镇痛药相关的药物不良反应发生率，与我们患者群体中的标准护理镇痛策略相比。次要结局是按类型和药物对药物不良反应进行亚组分析。本系统评价纳入了10项试验，其中6项为随机对照试验，在荟萃分析中进行了评估。在主要结局方面没有统计学显著差异（平均差异=-0.11，P=0.31，95%CI=[-0.35，0.13]）。对记录单一辅助镇痛药而非多模式方案的随机临床对照试验进行的亚组分析，按所遇到的不良反应类型和相关药物进行分层。关于特定ADE的发生率没有统计学显著发现。本研究中纳入的非随机数据支持这些发现。结论：虽然对多药联用中常见的累加有害不良反应的担忧是合理的，但我们的研究结果支持在重症非插管患者的镇痛中使用多模式镇痛方案。
