Joshi Girish P, Beloeil Helene, Lobo Dileep N, Pogatzki-Zahn Esther M, Sauter Axel R, Van de Velde Marc, Wu Christopher L, Kehlet Henrik
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA.
University of Rennes, CHU Rennes, Inserm, OSS 12142, CIC 1414, Anaesthesia and Intensive Care Department, Rennes, France.
Br J Anaesth. 2025 Mar;134(3):621-626. doi: 10.1016/j.bja.2024.11.004. Epub 2024 Nov 28.
Optimal postoperative pain management is a prerequisite for enhancing functional recovery after surgery. However, many studies assessing analgesic interventions have limitations. Consequently, further improvements in study design are urgently needed. In this focused editorial, we critically review prevalent trial designs and outcome measures including treatment-related adverse events evaluating analgesic interventions. Novel clinical trial designs should improve efficiency and enhance the likelihood of detecting relevant treatment effects. Cohort and database studies using propensity score matching and directed acyclic graphs could provide real-world generalisable information. Procedure-specific and patient-specific trials should allow identification of subpopulations most likely to benefit from a particular intervention after a specific surgical procedure and thus ascertain optimal analgesic strategies in challenging populations.
最佳的术后疼痛管理是提高术后功能恢复的前提条件。然而，许多评估镇痛干预措施的研究存在局限性。因此，迫切需要进一步改进研究设计。在这篇聚焦社论中，我们批判性地回顾了包括评估镇痛干预措施的治疗相关不良事件在内的普遍试验设计和结局指标。新颖的临床试验设计应提高效率，并增加检测相关治疗效果的可能性。使用倾向评分匹配和有向无环图的队列研究和数据库研究可以提供可推广到现实世界的信息。针对特定手术和特定患者的试验应能够识别出在特定手术后最有可能从特定干预措施中获益的亚组人群，从而确定在具有挑战性的人群中最佳的镇痛策略。
