Li Yihang, Yue Xinying, Liang Shuang, Ren Fei, Guo Qulian, Zou Wangyuan
Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China; National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Pain Physician. 2024 Nov;27(8):469-478.
Because of its side effects, a morphine replacement has been searched for in the field of postoperative analgesia. Hydromorphone is a derivative of morphine with no active metabolites.
We conducted a meta-analysis of hydromorphone and morphine to compare their clinical effects in postoperative analgesia.
Systematic review and meta-analysis.
The methodological quality of the studies included in this meta-analysis was assessed according to the Cochrane risk-of-bias tool. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria were used to evaluate the quality of evidence and recommendation grade for inclusion of randomized controlled trials. The primary outcome was postoperative pain score. Secondary outcomes were severe sedation, nausea, vomiting, and pruritus. The meta-analysis was performed using RevMan 5.4 (The Nordic Cochrane Centre for The Cochrane Collaboration).
Eight randomized controlled trials comprising 833 patients were found. There was no significant difference in pain scores between the hydromorphone and morphine groups at any measured postoperative time point: 8 hours (mean difference [MD] = -0.42; 95%CI, -2.08 to 1.24; P = 0.62); 12 hours (MD = -0.19; 95%CI, -0.62 to 0.24; P = 0.39); 24 hours (MD = -0.22; 95%CI, -0.54 to 0.09; P = 0.17); 36 hours (MD = 0.01; 95%CI, -0.67 to 0.69; P = 0.98) and 48 hours (MD = -0.14; 95%CI, -1.25 to 0.96; P = 0.80). There was no significant difference in the incidence of nausea and vomiting at 24 hours postoperative. The incidence of pruritus at 24 hours postoperative was lower in the hydromorphone group (relative risk = 0.24; 95%CI, 0.09 to 0.66; P = 0.005).
The perioperative multimodal analgesia measures were varying in the included studies, such as different medication doses. The sample size was small for some outcomes and high heterogeneity was observed.
There was no significant statistical difference in postoperative analgesic effect between hydromorphone and morphine, as well as side effects, including severe sedation, nausea, and vomiting at 24 hours postoperative. However, the incidence of pruritus was lower in the hydromorphone group at 24 hours postoperative.
由于吗啡的副作用，人们一直在术后镇痛领域寻找其替代品。氢吗啡酮是一种吗啡衍生物，没有活性代谢产物。
我们对氢吗啡酮和吗啡进行了一项荟萃分析，以比较它们在术后镇痛中的临床效果。
系统评价和荟萃分析。
根据Cochrane偏倚风险工具评估本荟萃分析中纳入研究的方法学质量。采用推荐分级评估、制定和评价（GRADE）标准来评估纳入随机对照试验的证据质量和推荐等级。主要结局是术后疼痛评分。次要结局是严重镇静、恶心、呕吐和瘙痒。使用RevMan 5.4（北欧Cochrane中心，Cochrane协作网）进行荟萃分析。
共纳入8项随机对照试验，涉及833例患者。在术后任何测量时间点，氢吗啡酮组和吗啡组的疼痛评分均无显著差异：术后8小时（平均差[MD]=-0.42；95%置信区间，-2.08至1.24；P=0.62）；12小时（MD=-0.19；95%置信区间，-0.62至0.24；P=0.39）；24小时（MD=-0.22；95%置信区间，-0.54至0.09；P=0.17）；36小时（MD=0.01；95%置信区间，-0.67至0.69；P=0.98）和48小时（MD=-0.14；95%置信区间，-1.25至0.96；P=0.80）。术后24小时恶心和呕吐的发生率无显著差异。氢吗啡酮组术后24小时瘙痒的发生率较低（相对风险=0.24；95%置信区间，0.09至0.66；P=0.005）。
纳入研究中的围手术期多模式镇痛措施各不相同，如药物剂量不同。一些结局的样本量较小，且观察到高度异质性。
氢吗啡酮和吗啡在术后镇痛效果以及包括术后24小时严重镇静、恶心和呕吐在内的副作用方面无显著统计学差异。然而，氢吗啡酮组术后24小时瘙痒的发生率较低。
