Liu Yijun, Ma Wei, Zuo Yunxia, Li Qian
Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Anaesth Crit Care Pain Med. 2025 Jan;44(1):101453. doi: 10.1016/j.accpm.2024.101453. Epub 2024 Dec 11.
There is still debate over whether opioid-free anaesthesia (OFA) can improve the patient-reported quality of recovery (QoR).
A search was conducted across Pubmed, Cochrane Library, and EMBASE until June 2024 for randomized controlled trials comparing the impact of OFA and opioid-based anaesthesia (OBA) on QoR in adult patients undergoing general anaesthesia. The primary outcome was the quality of recovery measured with the QoR scale. The secondary outcomes were the five dimensions of the QoR scale.
The analysis included 15 studies, and showed that compared with OBA, OFA improved the global QoR score at postoperative 24 h (SMD 0.87; 95% CI, 0.48-1.27; I: 92%; low-level evidence). Among them, 10 studies revealed a greater QoR-40 score at postoperative 24 h in the OFA than in the OBA (MD 6.59; 95% CI, 2.84-10.34; I: 93%; moderate-level evidence), which exceeded the minimal clinically important difference of 6.3. Conversely, the synthetic data of 4 studies did not reveal an improvement in the global QoR-15 score at postoperative 24 h (MD 9.94; 95% CI, -0.15 to 12.35; I: 97%; low-level evidence). Regarding different domains of scale, OFA had positive effects on physical comfort (SMD 0.75; 95% CI, 0.25-1.25; I: 93%; moderate-level evidence) and pain (SMD 0.59; 95% CI, 0.15-1.03; I: 91%; moderate-level evidence).
The meta-analysis indicate OFA can improve the quality of recovery at postoperative 24 h, particularly in terms of enhancing physical comfort and reducing pain. However, due to significant heterogeneity and moderate-to-low level of evidence, the external validity of OFA for improving postoperative recovery remains to be further validated.
The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database on December 07, 2023 (CRD42023486235).
关于无阿片类麻醉（OFA）是否能改善患者报告的恢复质量（QoR）仍存在争议。
在截至2024年6月的PubMed、Cochrane图书馆和EMBASE中进行检索，以查找比较OFA和基于阿片类药物的麻醉（OBA）对接受全身麻醉的成年患者QoR影响的随机对照试验。主要结局是用QoR量表测量的恢复质量。次要结局是QoR量表的五个维度。
分析纳入了15项研究，结果显示与OBA相比，OFA在术后24小时改善了总体QoR评分（标准化均值差0.87；95%置信区间，0.48 - 1.27；I²：92%；低质量证据）。其中，10项研究显示OFA组术后24小时的QoR - 40评分高于OBA组（平均差6.59；95%置信区间，2.84 - 10.34；I²：93%；中等质量证据），超过了最小临床重要差异6.3。相反，4项研究的综合数据未显示术后24小时总体QoR - 15评分有所改善（平均差9.94；95%置信区间， - 0.15至12.35；I²：97%；低质量证据）。关于量表的不同领域，OFA对身体舒适度（标准化均值差0.75；95%置信区间，0.25 - 1.25；I²：93%；中等质量证据）和疼痛（标准化均值差0.59；95%置信区间，0.15 - 1.03；I²：91%；中等质量证据）有积极影响。
荟萃分析表明，OFA可改善术后24小时的恢复质量，特别是在提高身体舒适度和减轻疼痛方面。然而，由于显著的异质性和中低质量的证据，OFA改善术后恢复的外部有效性仍有待进一步验证。
该方案于2023年12月7日在国际前瞻性系统评价注册库（PROSPERO）数据库中注册（CRD42023486235）。
