Zhang Zhen, Wang Jing-Jing, Ping Zhi-Guang, Jin Xiao-Gao, Yang Jian-Jun, Wang Yan, Chu Qin-Jun
Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, No. 16 Tongbai North Road, Zhengzhou, China.
College of Public Health, Zhengzhou University, Zhengzhou, China.
Pain Ther. 2025 Jul 25. doi: 10.1007/s40122-025-00762-2.
Opioids are commonly used for postoperative pain management but are associated with adverse effects and risk of dependence, potentially hindering recovery. This systematic review evaluates the impact of opioid-sparing analgesic strategies on postoperative pain and functional recovery to provide evidence-based guidance for clinical practice and future research.
A comprehensive systematic review and meta-analysis was conducted by searching PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials on adult surgical patients from the inception of each database to July 10, 2024. The primary outcome was the total morphine consumption within 24 h postoperatively. Secondary outcomes included postoperative pain scores at 24 h, patient satisfaction, length of stay, quality of recovery, and opioid-related adverse effects, such as postoperative nausea and vomiting (PONV), sedation, dizziness, drowsiness, pruritus, urinary retention, and hypotension.
A total of 58 studies (5614 patients) were included. The total morphine consumption was reduced, with a mean difference (MD) of -9.47, 95% confidence interval (95% CI) [-13, -5.95]. The postoperative pain score at 24 h was lower than in the control group, with an MD of -0.72 (95% CI [-0.97, -0.47]). Patient satisfaction was higher than in the control group, with an MD of 0.88 (95% CI [0.36, 1.40]). There were no significant differences in length of stay or recovery quality compared to the control group (P = 0.7, P = 0.48). The incidence of PONV was lower than the control group, with an odds ratio (OR) of 0.73 (95% CI [0.59, 0.90]), and the incidence of pruritus was also lower than in the control group, with an OR of 0.64 (95% CI [0.41, 0.98]). There were no differences in other adverse reactions compared to the control group.
The results of this meta-analysis indicate that, compared to opioid-based analgesia, opioid-sparing analgesia is associated with reduced morphine consumption within 24 h postoperatively, lower pain scores, and a decreased incidence of PONV and pruritus. Patient satisfaction was also improved. The findings will help clinicians make evidence-based decisions for postoperative pain management.
The protocol for this meta-analysis: PROSPERO CRD42024579882.
阿片类药物常用于术后疼痛管理，但会带来不良反应和依赖风险，可能会阻碍恢复。本系统评价评估了阿片类药物节省镇痛策略对术后疼痛和功能恢复的影响，为临床实践和未来研究提供循证指导。
通过检索PubMed、Embase、Web of Science和Cochrane图书馆，对从各数据库建库至2024年7月10日有关成年外科手术患者的随机对照试验进行了全面的系统评价和荟萃分析。主要结局是术后24小时内吗啡的总消耗量。次要结局包括术后24小时的疼痛评分、患者满意度、住院时间、恢复质量以及与阿片类药物相关的不良反应，如术后恶心呕吐（PONV）、镇静、头晕、嗜睡、瘙痒、尿潴留和低血压。
共纳入58项研究（5614例患者）。吗啡总消耗量减少，平均差（MD）为-9.47，95%置信区间（95%CI）[-13，-5.95]。术后24小时的疼痛评分低于对照组，MD为-0.72（95%CI[-0.97，-0.47]）。患者满意度高于对照组，MD为0.88（95%CI[0.36，1.40]）。与对照组相比，住院时间或恢复质量无显著差异（P=0.7，P=0.48）。PONV的发生率低于对照组，比值比（OR）为0.73（宽95%CI[0.59，0.90]），瘙痒的发生率也低于对照组，OR为0.64（95%CI[0.41，0.98]）。与对照组相比，其他不良反应无差异。
本荟萃分析结果表明，与基于阿片类药物的镇痛相比，阿片类药物节省镇痛与术后24小时内吗啡消耗量减少、疼痛评分降低以及PONV和瘙痒发生率降低相关。患者满意度也得到了提高。这些发现将有助于临床医生对术后疼痛管理做出循证决策。
本荟萃分析的方案：PROSPERO CRD42024579882。
