用于术后镇痛的缓释地那布芬 Sebacate 的有效性和安全性:系统回顾与元分析

IF 0.2 Q4 SURGERY
Yu-Lien Hsieh, Chi-Fei Wang, Chung-Ren Lin
{"title":"用于术后镇痛的缓释地那布芬 Sebacate 的有效性和安全性:系统回顾与元分析","authors":"Yu-Lien Hsieh, Chi-Fei Wang, Chung-Ren Lin","doi":"10.1097/fs9.0000000000000154","DOIUrl":null,"url":null,"abstract":"\n \n \n Multimodal analgesia, which combines multiple medications with different analgesic mechanisms, is recommended for optimizing postoperative pain control and minimizing opioid-related side effects. Dinalbuphine sebacate (DNS), a prodrug of nalbuphine, has a 7-day long-acting analgesic effect on moderate to severe postoperative pain. We conducted a systematic review and meta-analysis to analyze the efficacy and safety of dinalbuphine sebacate for postoperative pain management.\n \n \n \n We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials (RCTs) of DNS for postoperative analgesia. We assessed the quality of all included studies using the risk-of-bias tool. The primary outcome was postoperative pain score, and the secondary outcomes included analgesic consumption, need for rescue analgesics, adverse events, and length of hospital stay. A meta-analysis was performed for the pooled data, and the level of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.\n \n \n \n We included five RCTs with 497 patients who underwent surgery. Compared with the control group, DNS significantly reduced the visual analog scale (VAS) through postoperative 48 hours {mean difference (MD) -37.54 (95% confidence interval [CI]: -70.47, -4.62)} to 7 days [MD -165.99 (95% CI: -231.44)], and decreased the requirement for rescue analgesics [RR 0.89 (95% CI: 0.81, 0.97)]. No significant difference was noted in VAS scores within postoperative 24 hours [MD -10.13 (95% CI: -30.11, 9.85)] or in total analgesic consumption. Patients receiving DNS had a higher risk of dizziness and injection site reactions, without an increased occurrence of other adverse events.\n \n \n \n With a low-to-moderate level of evidence, intramuscular DNS provides long-lasting analgesia from postoperative 48 hours to 7 days and may reduce the requirement for postoperative rescue analgesics. However, DNS does not offer additional pain relief within the first 24 hours postoperatively. Further high-quality studies are warranted.\n International Prospective Register of Systematic Reviews (PROSPERO) registry: identifier: CRD42023494130\n","PeriodicalId":12390,"journal":{"name":"Formosan Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.2000,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy and Safety of Extended-Release Dinalbuphine Sebacate for Postoperative Analgesia: A Systematic Review and Meta-analysis\",\"authors\":\"Yu-Lien Hsieh, Chi-Fei Wang, Chung-Ren Lin\",\"doi\":\"10.1097/fs9.0000000000000154\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"\\n \\n \\n Multimodal analgesia, which combines multiple medications with different analgesic mechanisms, is recommended for optimizing postoperative pain control and minimizing opioid-related side effects. Dinalbuphine sebacate (DNS), a prodrug of nalbuphine, has a 7-day long-acting analgesic effect on moderate to severe postoperative pain. We conducted a systematic review and meta-analysis to analyze the efficacy and safety of dinalbuphine sebacate for postoperative pain management.\\n \\n \\n \\n We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials (RCTs) of DNS for postoperative analgesia. We assessed the quality of all included studies using the risk-of-bias tool. The primary outcome was postoperative pain score, and the secondary outcomes included analgesic consumption, need for rescue analgesics, adverse events, and length of hospital stay. A meta-analysis was performed for the pooled data, and the level of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.\\n \\n \\n \\n We included five RCTs with 497 patients who underwent surgery. Compared with the control group, DNS significantly reduced the visual analog scale (VAS) through postoperative 48 hours {mean difference (MD) -37.54 (95% confidence interval [CI]: -70.47, -4.62)} to 7 days [MD -165.99 (95% CI: -231.44)], and decreased the requirement for rescue analgesics [RR 0.89 (95% CI: 0.81, 0.97)]. No significant difference was noted in VAS scores within postoperative 24 hours [MD -10.13 (95% CI: -30.11, 9.85)] or in total analgesic consumption. Patients receiving DNS had a higher risk of dizziness and injection site reactions, without an increased occurrence of other adverse events.\\n \\n \\n \\n With a low-to-moderate level of evidence, intramuscular DNS provides long-lasting analgesia from postoperative 48 hours to 7 days and may reduce the requirement for postoperative rescue analgesics. However, DNS does not offer additional pain relief within the first 24 hours postoperatively. Further high-quality studies are warranted.\\n International Prospective Register of Systematic Reviews (PROSPERO) registry: identifier: CRD42023494130\\n\",\"PeriodicalId\":12390,\"journal\":{\"name\":\"Formosan Journal of Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.2000,\"publicationDate\":\"2024-07-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Formosan Journal of Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/fs9.0000000000000154\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Formosan Journal of Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/fs9.0000000000000154","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0

摘要

多模式镇痛结合了多种具有不同镇痛机制的药物,被推荐用于优化术后疼痛控制和减少阿片类药物相关副作用。癸二酸地那布品(DNS)是纳布啡的一种原药,对中重度术后疼痛具有 7 天长效镇痛作用。我们进行了一项系统综述和荟萃分析,以分析癸二酸地那布品治疗术后疼痛的有效性和安全性。 我们系统地检索了 PubMed、Embase 和 Cochrane 对照试验中央登记册,以确定 DNS 用于术后镇痛的随机对照试验 (RCT)。我们使用偏倚风险工具评估了所有纳入研究的质量。主要研究结果为术后疼痛评分,次要研究结果包括镇痛药消耗量、抢救镇痛药需求、不良事件和住院时间。我们对汇总数据进行了荟萃分析,并采用建议评估、发展和评价分级(GRADE)系统对证据等级进行了评定。 我们共纳入了 5 项研究,497 名患者接受了手术治疗。与对照组相比,DNS 显著降低了术后 48 小时{平均差 (MD) -37.54 (95% 置信区间 [CI]:-70.47, -4.62)}至 7 天[MD -165.99 (95% CI:-231.44)]的视觉模拟量表 (VAS),并减少了对镇痛药的需求[RR 0.89 (95% CI:0.81, 0.97)]。术后 24 小时内的 VAS 评分[MD -10.13 (95% CI: -30.11, 9.85)]和镇痛药总用量无明显差异。接受 DNS 治疗的患者出现头晕和注射部位反应的风险较高,但其他不良反应的发生率并未增加。 中低度证据显示,肌肉注射 DNS 可在术后 48 小时至 7 天内提供长效镇痛,并可减少术后抢救镇痛药的需求。然而,DNS 并不能在术后 24 小时内提供额外的镇痛效果。我们需要进一步开展高质量的研究。国际系统综述前瞻性登记(PROSPERO)登记:标识符:CRD42023494130
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Efficacy and Safety of Extended-Release Dinalbuphine Sebacate for Postoperative Analgesia: A Systematic Review and Meta-analysis
Multimodal analgesia, which combines multiple medications with different analgesic mechanisms, is recommended for optimizing postoperative pain control and minimizing opioid-related side effects. Dinalbuphine sebacate (DNS), a prodrug of nalbuphine, has a 7-day long-acting analgesic effect on moderate to severe postoperative pain. We conducted a systematic review and meta-analysis to analyze the efficacy and safety of dinalbuphine sebacate for postoperative pain management. We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials (RCTs) of DNS for postoperative analgesia. We assessed the quality of all included studies using the risk-of-bias tool. The primary outcome was postoperative pain score, and the secondary outcomes included analgesic consumption, need for rescue analgesics, adverse events, and length of hospital stay. A meta-analysis was performed for the pooled data, and the level of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. We included five RCTs with 497 patients who underwent surgery. Compared with the control group, DNS significantly reduced the visual analog scale (VAS) through postoperative 48 hours {mean difference (MD) -37.54 (95% confidence interval [CI]: -70.47, -4.62)} to 7 days [MD -165.99 (95% CI: -231.44)], and decreased the requirement for rescue analgesics [RR 0.89 (95% CI: 0.81, 0.97)]. No significant difference was noted in VAS scores within postoperative 24 hours [MD -10.13 (95% CI: -30.11, 9.85)] or in total analgesic consumption. Patients receiving DNS had a higher risk of dizziness and injection site reactions, without an increased occurrence of other adverse events. With a low-to-moderate level of evidence, intramuscular DNS provides long-lasting analgesia from postoperative 48 hours to 7 days and may reduce the requirement for postoperative rescue analgesics. However, DNS does not offer additional pain relief within the first 24 hours postoperatively. Further high-quality studies are warranted. International Prospective Register of Systematic Reviews (PROSPERO) registry: identifier: CRD42023494130
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
0.40
自引率
0.00%
发文量
32
审稿时长
11 weeks
期刊介绍: Formosan Journal of Surgery, a publication of Taiwan Surgical Association, is a peer-reviewed online journal with Bimonthly print on demand compilation of issues published. The journal’s full text is available online at http://www.e-fjs.org. The journal allows free access (Open Access) to its contents and permits authors to self-archive final accepted version of the articles on any OAI-compliant institutional / subject-based repository.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信