Efficacy and safety of neuraxial hydromorphone: A systematic review and meta-analysis with trial sequential analysis

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2024-10-22 DOI:10.1016/j.jclinane.2024.111664

Sina Grape , Kariem El-Boghdadly , Cécile Jaques , Eric Albrecht

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引用次数: 0

Abstract

Study objective

Neuraxial hydromorphone provides postoperative pain relief. However, the magnitude of this effect and the optimal dose remain unknown. The objective of this study is to clarify these uncertainties.

Design

Systematic review and meta-analysis with trial sequential analysis.

Setting

Postoperative recovery area and ward, up to 24 h.

Patients

Any patient undergoing any type of surgery or being in labor.

Interventions

Neuraxial hydromorphone versus control.

Measurements

Our primary outcome was rest pain score (analogue scale, 0–10) at 24 h according to route of administration (epidural versus spinal) and type of surgery (orthopedic versus other). Secondary outcomes included rest pain score at 0–4 and 8–12 h; rates of postoperative nausea and vomiting, and pruritus at 24 h.

Main results

Six trials, including 436 patients, were identified. Rest pain score at 24 postoperative hours was significantly reduced in the hydromorphone group, with a mean difference (95 %CI) of −0.4 (−0.8 to −0.1), I² = 74 %, p = 0.01. Neuraxial hydromorphone did not increase postoperative nausea and vomiting (risk ratio [95 %CI]: 1.2 [0.8–1.8], I² = 27 %, p = 0.47), but increases pruritus (risk ratio [95 %CI]: 3.1 [1.6–5.9], I² = 0 %, p = 0.0005). The quality of evidence was very low for our primary and secondary outcomes. In conclusion, there is very low level of evidence that neuraxial hydromorphone provides effective analgesia after surgery or labor, at the expense of an increased rate of pruritus. The improvement in pain scores appears to be clinically insignificant. With only six trials published over a period of 30 years, we were unable to perform a meta-regression.

Conclusions

If neuraxial hydromorphone is to be used regularly, trials focusing on the optimal dose and side-effects should be performed before widely administering this medication into the neuraxial space.

More trials focusing on the optimal dose and side-effects should be performed before widely administering this medication into the neuraxial space.

查看原文本刊更多论文

神经阻滞氢吗啡酮的疗效和安全性：系统回顾和荟萃分析与试验序列分析。

研究目的神经注射氢吗啡酮可缓解术后疼痛。然而，这种效果的大小和最佳剂量仍是未知数。本研究旨在澄清这些不确定性：设计：系统回顾和荟萃分析以及试验序列分析：环境：术后恢复区和病房，最长 24 小时：干预措施：椎管内注射氢吗啡酮：干预措施：神经注射氢吗啡酮与对照组：根据给药途径（硬膜外给药还是脊髓给药）和手术类型（骨科手术还是其他手术），我们的主要结果是 24 小时后的静息痛评分（模拟量表，0-10 分）。次要结果包括0-4小时和8-12小时的静息痛评分、术后恶心和呕吐率以及24小时的瘙痒率：主要结果：共确定了六项试验，包括 436 名患者。水吗啡酮组术后 24 小时的静息痛评分明显降低，平均差异（95 %CI）为-0.4（-0.8 至-0.1），I2 = 74 %，P = 0.01。神经注射氢吗啡酮不会增加术后恶心和呕吐（风险比 [95 %CI]：1.2 [0.8-1.8]，I2 = 27 %，p = 0.47），但会增加瘙痒（风险比 [95 %CI]：3.1 [1.6-5.9]，I2 = 0 %，p = 0.0005）。我们的主要和次要结果的证据质量都很低。总之，有极低水平的证据表明神经阻滞氢吗啡酮可在手术或分娩后提供有效镇痛，但会增加瘙痒率。疼痛评分的改善在临床上似乎并不显著。由于 30 年间只发表了六项试验，我们无法进行元回归分析：结论：如果要定期使用神经经颅氢吗啡酮，那么在广泛在神经经颅空间使用这种药物之前，应该先进行以最佳剂量和副作用为重点的试验。在神经经颅广泛使用这种药物之前，应进行更多试验，重点研究最佳剂量和副作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.