Ahmed H Abouarab, Rebecca Brülle, Mohamed Y Aboukilila, Stephanie Weibel, Alexander Schnabel
{"title":"围手术期氯胺酮预防慢性术后疼痛的有效性和安全性:一项荟萃分析。","authors":"Ahmed H Abouarab, Rebecca Brülle, Mohamed Y Aboukilila, Stephanie Weibel, Alexander Schnabel","doi":"10.1111/papr.13314","DOIUrl":null,"url":null,"abstract":"<p><strong>Study objective: </strong>Assessment of the efficacy and safety of perioperative intravenous ketamine in reducing incidence and severity of chronic postsurgical pain.</p><p><strong>Study design: </strong>A systematic review and meta-analysis of randomized controlled trials (RCTs).</p><p><strong>Data sources: </strong>The following data sources were systematically searched: MEDLINE, CENTRAL, and EMBASE (till 02/2021).</p><p><strong>Patients: </strong>Adult patients undergoing any surgery.</p><p><strong>Interventions: </strong>Perioperative use of intravenous ketamine as an additive analgesic drug compared to placebo, no active control treatment, and other additive drugs.</p><p><strong>Measurements: </strong>Primary outcomes were number of patients with chronic postsurgical pain after 6 months and ketamine related adverse effects. Secondary outcomes were chronic postsurgical pain incidence after 3 and 12 months, chronic postsurgical neuropathic pain incidence, chronic postsurgical moderate to severe pain incidence, intensity of chronic postsurgical pain at rest, and during movement, oral morphine consumption after 3, 6, and 12 months and incidence of opioid-related adverse effects.</p><p><strong>Main results: </strong>Thirty-six RCTs were included with a total of 3572 patients. Ketamine compared to placebo may result in no difference in the number of patients with chronic postsurgical pain after 6 months (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.71-1.05; I<sup>2</sup> = 34%; 16 studies; low-certainty evidence). Ketamine may reduce the incidence of chronic postsurgical neuropathic pain after 3 months in comparison to placebo (RR 0.78, 95% CI 0.62-0.99, I<sup>2</sup> = 31%, seven trials, low-certainty evidence). Ketamine compared to placebo may increase the risk for postoperative nystagmus (RR 9.04, 95% CI 1.15-70.90, I<sup>2</sup> 30%, two trials, low-certainty evidence) and postoperative visual disturbances (RR 2.29, 95% CI 1.05-4.99, I<sup>2</sup> 10%, seven trials, low-certainty evidence).</p><p><strong>Conclusions: </strong>There is low-certainty evidence that perioperative ketamine has no effect on chronic postsurgical pain in adult patients. Low-certainty evidence suggests that ketamine compared to placebo may reduce incidence of chronic postsurgical neuropathic pain after 3 months. Questions like ideal dosing, treatment duration and more patient-related outcome measures remain unanswered, which warrants further studies.</p><p><strong>Protocol registration: </strong>Prospero CRD42021223625, 07.01.2021.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":null,"pages":null},"PeriodicalIF":2.5000,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy and safety of perioperative ketamine for the prevention of chronic postsurgical pain: A meta-analysis.\",\"authors\":\"Ahmed H Abouarab, Rebecca Brülle, Mohamed Y Aboukilila, Stephanie Weibel, Alexander Schnabel\",\"doi\":\"10.1111/papr.13314\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study objective: </strong>Assessment of the efficacy and safety of perioperative intravenous ketamine in reducing incidence and severity of chronic postsurgical pain.</p><p><strong>Study design: </strong>A systematic review and meta-analysis of randomized controlled trials (RCTs).</p><p><strong>Data sources: </strong>The following data sources were systematically searched: MEDLINE, CENTRAL, and EMBASE (till 02/2021).</p><p><strong>Patients: </strong>Adult patients undergoing any surgery.</p><p><strong>Interventions: </strong>Perioperative use of intravenous ketamine as an additive analgesic drug compared to placebo, no active control treatment, and other additive drugs.</p><p><strong>Measurements: </strong>Primary outcomes were number of patients with chronic postsurgical pain after 6 months and ketamine related adverse effects. Secondary outcomes were chronic postsurgical pain incidence after 3 and 12 months, chronic postsurgical neuropathic pain incidence, chronic postsurgical moderate to severe pain incidence, intensity of chronic postsurgical pain at rest, and during movement, oral morphine consumption after 3, 6, and 12 months and incidence of opioid-related adverse effects.</p><p><strong>Main results: </strong>Thirty-six RCTs were included with a total of 3572 patients. Ketamine compared to placebo may result in no difference in the number of patients with chronic postsurgical pain after 6 months (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.71-1.05; I<sup>2</sup> = 34%; 16 studies; low-certainty evidence). Ketamine may reduce the incidence of chronic postsurgical neuropathic pain after 3 months in comparison to placebo (RR 0.78, 95% CI 0.62-0.99, I<sup>2</sup> = 31%, seven trials, low-certainty evidence). Ketamine compared to placebo may increase the risk for postoperative nystagmus (RR 9.04, 95% CI 1.15-70.90, I<sup>2</sup> 30%, two trials, low-certainty evidence) and postoperative visual disturbances (RR 2.29, 95% CI 1.05-4.99, I<sup>2</sup> 10%, seven trials, low-certainty evidence).</p><p><strong>Conclusions: </strong>There is low-certainty evidence that perioperative ketamine has no effect on chronic postsurgical pain in adult patients. Low-certainty evidence suggests that ketamine compared to placebo may reduce incidence of chronic postsurgical neuropathic pain after 3 months. 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引用次数: 0
摘要
研究目的:评价围手术期静脉注射氯胺酮降低术后慢性疼痛发生率和严重程度的有效性和安全性。研究设计:随机对照试验(rct)的系统评价和荟萃分析。数据来源:系统检索了以下数据源:MEDLINE、CENTRAL和EMBASE(截至2021年2月)。患者:接受任何手术的成年患者。干预措施:围手术期静脉注射氯胺酮作为加性镇痛药物，与安慰剂、无主动对照治疗和其他加性药物进行比较。测量:主要结局是6个月后出现慢性术后疼痛的患者数量和氯胺酮相关的不良反应。次要结局包括术后3个月和12个月慢性疼痛发生率、术后慢性神经性疼痛发生率、术后慢性中度至重度疼痛发生率、术后静息和运动时慢性疼痛强度、术后3个月、6个月和12个月口服吗啡用量以及阿片类药物相关不良反应发生率。主要结果:纳入36项随机对照试验，共3572例患者。氯胺酮与安慰剂相比，6个月后出现慢性术后疼痛的患者数量可能没有差异(风险比(RR) 0.86, 95%可信区间(CI) 0.71-1.05;I2 = 34%;16研究;确定性的证据)。与安慰剂相比，氯胺酮可降低术后3个月慢性神经性疼痛的发生率(RR 0.78, 95% CI 0.62-0.99, I2 = 31%， 7项试验，低确定性证据)。与安慰剂相比，氯胺酮可能增加术后眼球震颤(RR 9.04, 95% CI 1.15-70.90, I2 30%， 2项试验，低确定性证据)和术后视力障碍(RR 2.29, 95% CI 1.05-4.99, I2 10%， 7项试验，低确定性证据)的风险。结论:有低确定性证据表明，围手术期氯胺酮对成年患者的慢性术后疼痛没有影响。低确定性证据表明，与安慰剂相比，氯胺酮可以在3个月后降低慢性术后神经性疼痛的发生率。诸如理想剂量、治疗时间和更多与患者相关的结果测量等问题仍未得到解答，这需要进一步的研究。协议注册:普洛斯彼罗CRD42021223625, 07.01.2021。
Efficacy and safety of perioperative ketamine for the prevention of chronic postsurgical pain: A meta-analysis.
Study objective: Assessment of the efficacy and safety of perioperative intravenous ketamine in reducing incidence and severity of chronic postsurgical pain.
Study design: A systematic review and meta-analysis of randomized controlled trials (RCTs).
Data sources: The following data sources were systematically searched: MEDLINE, CENTRAL, and EMBASE (till 02/2021).
Patients: Adult patients undergoing any surgery.
Interventions: Perioperative use of intravenous ketamine as an additive analgesic drug compared to placebo, no active control treatment, and other additive drugs.
Measurements: Primary outcomes were number of patients with chronic postsurgical pain after 6 months and ketamine related adverse effects. Secondary outcomes were chronic postsurgical pain incidence after 3 and 12 months, chronic postsurgical neuropathic pain incidence, chronic postsurgical moderate to severe pain incidence, intensity of chronic postsurgical pain at rest, and during movement, oral morphine consumption after 3, 6, and 12 months and incidence of opioid-related adverse effects.
Main results: Thirty-six RCTs were included with a total of 3572 patients. Ketamine compared to placebo may result in no difference in the number of patients with chronic postsurgical pain after 6 months (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.71-1.05; I2 = 34%; 16 studies; low-certainty evidence). Ketamine may reduce the incidence of chronic postsurgical neuropathic pain after 3 months in comparison to placebo (RR 0.78, 95% CI 0.62-0.99, I2 = 31%, seven trials, low-certainty evidence). Ketamine compared to placebo may increase the risk for postoperative nystagmus (RR 9.04, 95% CI 1.15-70.90, I2 30%, two trials, low-certainty evidence) and postoperative visual disturbances (RR 2.29, 95% CI 1.05-4.99, I2 10%, seven trials, low-certainty evidence).
Conclusions: There is low-certainty evidence that perioperative ketamine has no effect on chronic postsurgical pain in adult patients. Low-certainty evidence suggests that ketamine compared to placebo may reduce incidence of chronic postsurgical neuropathic pain after 3 months. Questions like ideal dosing, treatment duration and more patient-related outcome measures remain unanswered, which warrants further studies.
期刊介绍：
Pain Practice, the official journal of the World Institute of Pain, publishes international multidisciplinary articles on pain and analgesia that provide its readership with up-to-date research, evaluation methods, and techniques for pain management. Special sections including the Consultant’s Corner, Images in Pain Practice, Case Studies from Mayo, Tutorials, and the Evidence-Based Medicine combine to give pain researchers, pain clinicians and pain fellows in training a systematic approach to continuing education in pain medicine. Prior to publication, all articles and reviews undergo peer review by at least two experts in the field.
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