成人术后疼痛的急性疼痛服务：一项网状Meta分析。

Acute pain service for postoperative pain in adults: a network meta-analysis.

作者信息

Chen Lu, Feng Xixia, Ye Ling, Yang Jiaqi, Zhou Ruihao, Qiu Yong, Chen Guo, Zhu Tao

机构信息

Department of Anesthesiology, National Clinical Research Center for Geriatrics and The Research Units of West China (2018RU012), West China Hospital, Sichuan University, Chengdu, China.

Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.

出版信息

Int J Surg. 2025 Jun 1;111(6):4009-4019. doi: 10.1097/JS9.0000000000002419. Epub 2025 Apr 22.

DOI:10.1097/JS9.0000000000002419

PMID:40265484

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12165480/

Abstract

BACKGROUND

Postoperative pain significantly impacts patients' quality of life and recovery. Although acute pain services (APS) have been implemented in many hospitals worldwide, no study has directly compared the efficacy of different APS subtypes in managing acute postoperative pain.

OBJECTIVE

This network meta-analysis aimed to evaluate the effectiveness of various APS models in alleviating postoperative pain in adults undergoing surgery.

METHODS

Four English-language databases (PubMed, Web of Science, Embase, and Cochrane Library) and three Chinese-language databases (CNKI, WANFANG, and SinoMed) were searched to identify randomized controlled trials (RCTs) that compared the efficacy of different pain management models for postoperative pain in adult patients. Statistical analyses were conducted using R version 4.4.2 and Stata version 18.

RESULTS

A total of 38 studies were included in this network meta-analysis. All APS subtypes demonstrated superior pain relief compared to the traditional ward doctor-nurse model. These included nurse-based anesthesiologist specialist-supervised APS (NBASS-APS; SMD: -1.99, 99% CI: -2.55, -1.43), nurse-based anesthesiologist-supervised APS (NBAS-APS; SMD: -1.44, 99% CI: -2.18, -0.70), pain management multidisciplinary team (PMDT; SMD: -1.31, 99% CI: -1.74, -0.87), and conventional APS (C-APS; SMD: -0.83, 99% CI: -1.43, -0.24). Surface under the cumulative ranking (SUCRA) analysis identified NBASS-APS as having the highest probability of achieving optimal pain relief (98.0%), followed by NBAS-APS (65.9%), PMDT (58.0%), C-APS (28.1%), and the traditional model (0.1%).

CONCLUSION

APS models are significantly more effective than the traditional ward doctor-nurse model in relieving postoperative pain, with NBASS-APS emerging as the most promising approach, followed by NBAS-APS, PMDT, and C-APS.

摘要

背景

术后疼痛显著影响患者的生活质量和康复。尽管全球许多医院都已实施急性疼痛服务（APS），但尚无研究直接比较不同APS亚型在管理急性术后疼痛方面的疗效。

目的

这项网络荟萃分析旨在评估各种APS模式对接受手术的成人缓解术后疼痛的有效性。

方法

检索了四个英文数据库（PubMed、Web of Science、Embase和Cochrane图书馆）和三个中文数据库（中国知网、万方和中国生物医学文献数据库），以识别比较不同疼痛管理模式对成年患者术后疼痛疗效的随机对照试验（RCT）。使用R 4.4.2版本和Stata 18版本进行统计分析。

结果

本网络荟萃分析共纳入38项研究。与传统病房医生-护士模式相比，所有APS亚型均显示出更好的疼痛缓解效果。这些亚型包括护士主导的麻醉专科医生监督的APS（NBASS-APS；标准化均数差：-1.99，99%可信区间：-2.55，-1.43）、护士主导的麻醉医生监督的APS（NBAS-APS；标准化均数差：-1.44，99%可信区间：-2.18，-0.70）、疼痛管理多学科团队（PMDT；标准化均数差：-1.31，99%可信区间：-1.74，-0.87）和传统APS（C-APS；标准化均数差：-0.83，99%可信区间：-1.43，-0.24）。累积排序曲线下面积（SUCRA）分析确定NBASS-APS实现最佳疼痛缓解的概率最高（98.0%），其次是NBAS-APS（65.9%）、PMDT（58.0%）、C-APS（28.1%）和传统模式（0.1%）。