Stephanie Elizabeth Harris MBBS (Hons), Jeremy Szmerling BPharm (Hons), ANZCAP-Reg (PainMgmt, Steward), Diarna Abbott BNurs, GCertAdNurs (Periop), Enwu Liu BSc, BMed, MSc, PhD, John Oldroyd BSc, MPH, PhD
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引用次数: 0
摘要
目的本研究的目的是进行系统回顾和荟萃分析，以确定口服和舌下氯胺酮在疼痛管理中的有效性。采用MEDLINE、CINAHL、Embase和Web of Science四个数据库进行系统检索。研究选择该研究包括随机对照试验，调查口服或舌下氯胺酮在住院或门诊疼痛管理中的使用，并与任何其他口服或舌下比较药物（包括安慰剂）进行比较。结果21项研究纳入系统评价，均评价口服氯胺酮，其中一项比较口服氯胺酮与舌下氯胺酮。其中，12项研究评估了口服氯胺酮对程序性疼痛的影响，其中10项研究发现口服氯胺酮在减轻程序性疼痛方面明显优于比较物。两项研究聚焦于口服氯胺酮治疗术后疼痛，均发现与安慰剂相比，口服氯胺酮减少了对额外镇痛的需求。五项研究调查了口服氯胺酮治疗慢性疼痛的结果各不相同。在剩下的两项研究中，一项比较了不同剂量的口服氯胺酮，另一项比较了口服氯胺酮和舌下氯胺酮。15项研究纳入meta分析。其中，有7项研究将口服氯胺酮与安慰剂进行比较，发现口服氯胺酮在减轻疼痛方面优于安慰剂（p < 0.01）。8项研究将口服氯胺酮与其他口服药物如美沙酮、可待因、咪达唑仑和右美托咪定进行了比较，结果显示口服氯胺酮在减轻疼痛方面没有显著的效果（p = 0.18）。结论口服氯胺酮是一种有效的手术镇痛药。
The effectiveness of oral and sublingual ketamine in pain management: a systematic review and meta-analysis
Aim
The aim of this study was to undertake a systematic review and meta-analysis to determine the effectiveness of oral and sublingual ketamine in pain management.
Data Sources
A systematic search was conducted utilising four databases: MEDLINE, CINAHL, Embase, and Web of Science.
Study Selection
The study included randomised controlled trials investigating the use of oral or sublingual ketamine in the management of pain in inpatient or outpatient settings compared to any alternative oral or sublingual comparator, including placebo.
Results
Twenty-one studies were included for systematic review, all assessing oral ketamine, including one comparing oral to sublingual ketamine. Of these, 12 studies evaluated oral ketamine in procedural pain, with 10 studies finding oral ketamine significantly better than the comparator at reducing procedural pain. Two studies focused on oral ketamine in postoperative pain, both finding oral ketamine reduced the requirement for additional analgesia compared to placebo. Five studies investigated oral ketamine in chronic pain with heterogenous results. Of the remaining two studies, one compared various doses of oral ketamine and the other compared oral to sublingual ketamine.
Fifteen studies were included for meta-analysis. Among them, seven studies compared oral ketamine to placebo and found oral ketamine was superior to placebo in reducing pain (p < 0.01). Eight studies compared oral ketamine to other oral medications such as methadone, codeine, midazolam, and dexmedetomidine and showed no significant benefit of oral ketamine in reducing pain (p = 0.18).
Conclusion
The results suggest oral ketamine is an effective analgesic in the procedural setting.
期刊介绍：
The purpose of this document is to describe the structure, function and operations of the Journal of Pharmacy Practice and Research, the official journal of the Society of Hospital Pharmacists of Australia (SHPA). It is owned, published by and copyrighted to SHPA. However, the Journal is to some extent unique within SHPA in that it ‘…has complete editorial freedom in terms of content and is not under the direction of the Society or its Council in such matters…’. This statement, originally based on a Role Statement for the Editor-in-Chief 1993, is also based on the definition of ‘editorial independence’ from the World Association of Medical Editors and adopted by the International Committee of Medical Journal Editors.
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