腹部微创手术的无阿片麻醉：系统综述、荟萃分析和试验序列分析。

IF 3.4 3区医学 Q1 ANESTHESIOLOGY

Canadian Journal of Anesthesia-Journal Canadien D Anesthesie Pub Date : 2024-11-05 DOI:10.1007/s12630-024-02831-0

Carlos A B da Silveira, Ana C D Rasador, Heitor J S Medeiros, Eric Slawka, Lucca Gesteira, Lucas C Pereira, Sara Amaral

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引用次数: 0

摘要

目的：阿片类药物麻醉通常用于微创手术，但会产生不良反应，包括术后恶心和呕吐（PONV）。无阿片麻醉旨在减轻这些问题。我们进行了一项系统综述、荟萃分析和试验序列分析（TSA），比较了腹部微创手术中的阿片类和无阿片类麻醉：我们在 Cochrane Central Register of Controlled Trials、MEDLINE 和 Embase 中检索了比较这些方法的随机对照试验 (RCT)。我们的主要结果是不良反应（PONV、心动过缓），次要结果是疼痛、阿片类药物用量和麻醉后护理病房（PACU）的住院时间（LOS）。我们进行了一项TSA，以调查研究结果的确凿性：结果：我们纳入了 26 项 RCT，涉及 2,025 名患者，其中无阿片类药物麻醉组有 1,009 人（49%）。无阿片麻醉可显著降低 PONV（风险比为 0.55；95% 置信区间 [CI]，0.40 至 0.74；P 结论：无阿片麻醉可显著降低 PONV（风险比为 0.55；95% 置信区间 [CI]，0.40 至 0.74）：无阿片麻醉显著降低了PONV，减少了术后2小时内阿片类药物的用量，这表明无阿片麻醉可以替代阿片类药物麻醉用于微创腹部手术：研究注册：PROSPERO ( CRD42023492385 )；2023 年 12 月 18 日首次提交。

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Opioid-free anesthesia for minimally invasive abdominal surgery: a systematic review, meta-analysis, and trial sequential analysis.

Purpose: Opioid anesthesia is commonly employed in minimally invasive surgeries but is associated with adverse effects, including postoperative nausea and vomiting (PONV). Opioid-free anesthesia aims to mitigate these issues. We conducted a systematic review, meta-analysis, and trial sequential analysis (TSA) comparing opioid and opioid-free anesthesia in minimally invasive abdominal surgeries.

Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for randomized controlled trials (RCTs) comparing these approaches. Our primary outcomes were adverse effects (PONV, bradycardia), while secondary outcomes were pain, opioid consumption, and postanesthesia care unit (PACU) length of stay (LOS). We performed a TSA to investigate the conclusiveness of the results.

Results: We included 26 RCTs encompassing 2,025 patients, with 1,009 (49%) in the opioid-free anesthesia group. Opioid-free anesthesia reduced PONV significantly (risk ratio, 0.55; 95% confidence interval [CI], 0.40 to 0.74; P < 0.001), but we found no significant differences in bradycardia rates. We found nonclinically relevant higher pain scores for opioid anesthesia (mean difference [MD], -0.9; 95% CI, -1.7 to -0.2; P = 0.01) and opioid consumption at 2 hr post surgery (MD, -5.4 mg oral morphine equivalents; 95% CI, -9.1 to -1.8; P = 0.004). We also noted a reduced time to first analgesia (MD, 88 min; 95% CI, 18 to 159; P = 0.01). We found no differences in PACU LOS. The TSA confirmed the sample size's adequacy in showing PONV reduction with opioid-free anesthesia.

Conclusion: Opioid-free anesthesia showed a significant reduction in PONV and a decrease in opioid consumption during the first 2 hr postoperatively, suggesting it can be an alternative to opioid anesthesia in minimally invasive abdominal surgeries.

Study registration: PROSPERO ( CRD42023492385 ); first submitted 18 December 2023.

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来源期刊

Canadian Journal of Anesthesia-Journal Canadien D Anesthesie 医学-麻醉学

CiteScore

8.50

自引率

7.10%

发文量

161

审稿时长

6-12 weeks

期刊介绍： The Canadian Journal of Anesthesia (the Journal) is owned by the Canadian Anesthesiologists’ Society and is published by Springer Science + Business Media, LLM (New York). From the first year of publication in 1954, the international exposure of the Journal has broadened considerably, with articles now received from over 50 countries. The Journal is published monthly, and has an impact Factor (mean journal citation frequency) of 2.127 (in 2012). Article types consist of invited editorials, reports of original investigations (clinical and basic sciences articles), case reports/case series, review articles, systematic reviews, accredited continuing professional development (CPD) modules, and Letters to the Editor. The editorial content, according to the mission statement, spans the fields of anesthesia, acute and chronic pain, perioperative medicine and critical care. In addition, the Journal publishes practice guidelines and standards articles relevant to clinicians. Articles are published either in English or in French, according to the language of submission.