McQuay H J
Oxford Pain Relief Unit, Churchill Hospital, UK.
Ann Med. 1995 Apr;27(2):249-56. doi: 10.3109/07853899509031967.
Basic scientific evidence suggests that an analgesic intervention made before surgery will produce a better outcome than the same intervention made after surgery. The evidence from randomized controlled trials (RCTs) which tested this hypothesis in patients is reviewed. Four studies with paracetamol or NSAIDs did not show any pre-emptive effect. Of seven studies with local anaesthetic six did not show a pre-emptive effect. In the four studies with opioids there was weak evidence of a pre-emptive effect in three. There are few perfect RCTs, and unfortunately this rule applies in the pre-emptive analgesia field. Many of the studies which did not show a pre-emptive effect lacked power. The opioid studies which did show a pre-emptive effect had other technical weaknesses. One way to combat lack of power would be to combine data (meta-analysis). This is very difficult in this field because of the outcome measures which investigators are using.
基础科学证据表明，术前进行镇痛干预比术后进行相同干预能产生更好的效果。本文回顾了在患者中检验该假设的随机对照试验（RCT）的证据。四项关于对乙酰氨基酚或非甾体抗炎药的研究未显示出任何超前镇痛效果。七项关于局部麻醉药的研究中有六项未显示出超前镇痛效果。在四项关于阿片类药物的研究中，三项有微弱的超前镇痛效果证据。完美的随机对照试验很少，不幸的是，这条规则也适用于超前镇痛领域。许多未显示超前镇痛效果的研究缺乏效力。确实显示出超前镇痛效果的阿片类药物研究存在其他技术缺陷。解决效力不足的一种方法是合并数据（荟萃分析）。由于研究人员所使用的结局指标，在该领域这非常困难。
