与阿片类药物麻醉相比，无阿片类药物麻醉的有效性和安全性：一项系统评价和网状荟萃分析。
Effectiveness and safety of opioid-free anesthesia compared to opioid-based anesthesia: a systematic review and network meta-analysis.
作者信息
Tripodi Vincenzo Francesco, Sardo Salvatore, Ippolito Mariachiara, Cortegiani Andrea
机构信息
Anesthesia and Intensive Care, Human Pathology Department, University Hospital "Gaetano Martino", Via Consolare Valeria 1, Messina, 98124, Italy.
Department of Medical Sciences and Public Health, University of Cagliari, Strada Provinciale 8, Monserrato, 09042, Italy.
出版信息
J Anesth Analg Crit Care. 2025 Aug 13;5(1):53. doi: 10.1186/s44158-025-00272-9.
BACKGROUND
Opioid-free anesthesia (OFA) is an innovative approach to anesthesia management aimed at enhancing both the safety and the quality of perioperative outcomes. The efficacy and safety of these approaches are uncertain. The aim of our work was to compare the effectiveness and safety of different OFA regimens to opioid-based anesthesia (OBA).
STUDY DESIGN AND METHODS
We conducted a systematic review and frequentist random-effects network meta-analysis of randomized controlled trials (RCTs). The primary outcome measure was the intensity of postoperative pain at 24 h, expressed in terms of numerical rating scale (NRS), visual analogue scale (VAS), or verbal rating scale (VRS) scores. The SUCRA was used to determine the likelihood that an intervention was ranked as the best. The certainty of the evidence was assessed according to the GRADE methodology for Network Meta-analysis (NMA).
RESULTS
A total of 42 RCTs were included, for a total of 4666 patients. We have addressed the variety of available interventions. The random-effects network meta-analysis comparing OBA and different OFA regimens showed no difference in the pain intensity at 24 h. We performed the GRADE assessment for each comparison between each OFA regimen and OBA as a comparator. The certainty of evidence for the primary outcome ranges from moderate to very low among the different comparisons.
CONCLUSIONS
We have identified a significant heterogeneity in OFA regimens evaluated and a moderate to high risk of bias in over 70% of studies reporting the primary outcome. No OFA regimens showed a statistically significant effect over OBA in reducing postoperative pain within the first 24 h following surgery. Current evidence does not support the superiority of the analgesic efficacy of OFA in the immediate postoperative period compared to the use of opioids.
TRIAL REGISTRATION
This study is registered in PROSPERO with the registration number CRD42024529236 (May 3, 2024).
背景
无阿片类药物麻醉（OFA）是一种创新的麻醉管理方法，旨在提高围手术期结局的安全性和质量。这些方法的有效性和安全性尚不确定。我们研究的目的是比较不同OFA方案与基于阿片类药物的麻醉（OBA）的有效性和安全性。
研究设计与方法
我们对随机对照试验（RCT）进行了系统评价和频率学派随机效应网络荟萃分析。主要结局指标是术后24小时的疼痛强度，用数字评分量表（NRS）、视觉模拟量表（VAS）或语言评分量表（VRS）评分表示。SUCRA用于确定一种干预措施被评为最佳的可能性。根据网络荟萃分析（NMA）的GRADE方法评估证据的确定性。
结果
共纳入42项RCT，涉及4666例患者。我们研究了各种可用的干预措施。比较OBA和不同OFA方案的随机效应网络荟萃分析显示，24小时时疼痛强度无差异。我们对每种OFA方案与作为对照的OBA之间的每次比较进行了GRADE评估。在不同的比较中，主要结局的证据确定性从中度到极低不等。
结论
我们发现所评估的OFA方案存在显著异质性，超过70%报告主要结局的研究存在中度至高度偏倚风险。在术后24小时内，没有OFA方案在减轻术后疼痛方面显示出比OBA有统计学意义的效果。目前的证据不支持与使用阿片类药物相比，OFA在术后即刻镇痛效果上具有优越性。
试验注册
本研究已在PROSPERO注册，注册号为CRD42024529236（2024年5月3日）。
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