Single dose oral analgesics for acute postoperative pain in adults.
Single dose oral analgesics for acute postoperative pain in adults.
复制标题
DOI：
10.1002/14651858.cd008659.pub2
复制
发表时间：
2011-09-07
影响因子：
8.4
通讯作者：
Wiffen, Philip J.
中科院分区：
文献类型：
--
作者：
Moore, R. Andrew;Derry, Sheena;McQuay, Henry J.;Wiffen, Philip J.
已经发表了35篇Cochrane综述，综述了随机试验对单个药物干预治疗急性术后疼痛的镇痛效果。本概述汇集了所有这些审查的结果，并评估了可用数据的可靠性。总结所有Cochrane综述的数据，这些综述评估了药物干预对手术后至少中度疼痛的成人急性疼痛的影响，这些患者单独服用单剂量口服止痛药。我们通过简单的搜索策略在Cochrane图书馆中找到了系统评价。所有的评价都由一个单一的评价组进行监督，有一个标准的标题，并且与安慰剂相比，在4到6小时内至少缓解了50%疼痛的参与者人数是他们的主要结局。对于个体评价，我们提取了每种药物/剂量组合的该结果所需治疗数（NNT），以及达到至少50%最大疼痛缓解的参与者百分比，再用药的平均或中位数时间的平均值，治疗6、8、12或24小时的参与者百分比，以及至少经历一次不良事件的参与者的结果。该综述包括35篇独立的Cochrane综述，其中38篇分析了单剂量口服镇痛药在急性术后疼痛模型中的测试，结果来自大约350项独立研究的45,000名参与者。个别评价仅包括标准化设计和结果报告的高质量试验。这些评价采用了标准化的方法并报告了疗效和危害。安慰剂组的事件发生率在更大的数据集中是一致的。没有进行统计比较。有文献回顾，但没有关于阿西美他星、美洛昔康、那布美酮、奈福泮、舒林达克、替诺昔康和硫丙酸的试验数据。关于地西布洛芬、右丙氧芬130毫克、地氟尼松125毫克、依托昔布60毫克、芬布芬和吲哚美辛的数据不足。如果有足够的药物/剂量组合信息（至少200名参与者，至少两项研究），我们定义了4个典型规模（总共400名参与者）的零效应的附加比较，使结果可能受到发表偏倚的影响，因此不可靠。在所有术后疼痛情况下，46种药物/剂量组合获得了可靠的结果；45人有牙痛，14人有其他疼痛症状。与安慰剂相比，在4至6小时内，NNTs在1.5至20之间变化，最大疼痛缓解至少50%。在相同的疼痛条件下，达到这种水平的受益的参与者比例从30%到70%以上不等，重新用药的时间从2小时（安慰剂）到20小时以上不等。报告至少有一个不良事件的参与者很少，而且在活性药物和安慰剂之间通常没有区别，只有少数例外，主要是阿司匹林和阿片类药物。具有良好（低）NNTs的药物/剂量组合为布洛芬400 mg（2.5； 95%置信区间（CI） 2.4至2.6）、双氯芬酸50 mg （2.7; 95% CI 2.4至3.0）、依托昔布120 mg （1.9; 95% CI 1.7至2.1）、可待因60 mg +扑热息痛1000 mg （2.2; 95% CI 1.8至2.9）、塞来昔布400 mg （2.5; 95% CI 2.2至2.9）和萘普生500/550 mg （2.7; 95% CI 2.3至3.3）。依托昔布120毫克，双氟尼拉500毫克，羟考酮10毫克+扑热息痛650毫克，萘普生500/550毫克，塞来昔布400毫克的作用时间较长（8小时）。并非所有的参与者都有良好的疼痛缓解，对于许多药物/剂量组合，50%或更多的药物在4到6小时内不能达到至少50%的最大疼痛缓解。单剂量口服镇痛药的镇痛效果有大量可靠的证据。对于没有数据、数据不充分或由于易受发表偏倚影响结果不可靠的药物，也有重要的信息。这应该为专业人士和消费者的选择提供信息。
Thirty-five Cochrane Reviews of randomised trials testing the analgesic efficacy of individual drug interventions in acute postoperative pain have been published. This overview brings together the results of all those reviews and assesses the reliability of available data. To summarise data from all Cochrane Reviews that have assessed the effects of pharmaceutical interventions for acute pain in adults with at least moderate pain following surgery, who have been given a single dose of oral analgesic taken alone. We identified systematic reviews in The Cochrane Library through a simple search strategy. All reviews were overseen by a single Review Group, had a standard title, and had as their primary outcome numbers of participants with at least 50% pain relief over four to six hours compared with placebo. For individual reviews we extracted the number needed to treat (NNT) for this outcome for each drug/dose combination, and also the percentage of participants achieving at least 50% maximum pain relief, the mean of mean or median time to remedication, the percentage of participants remedicating by 6, 8, 12, or 24 hours, and results for participants experiencing at least one adverse event. The overview included 35 separate Cochrane Reviews with 38 analyses of single dose oral analgesics tested in acute postoperative pain models, with results from about 45,000 participants studied in approximately 350 individual studies. The individual reviews included only high-quality trials of standardised design and outcome reporting. The reviews used standardised methods and reporting for both efficacy and harm. Event rates with placebo were consistent in larger data sets. No statistical comparison was undertaken. There were reviews but no trial data were available for acemetacin, meloxicam, nabumetone, nefopam, sulindac, tenoxicam, and tiaprofenic acid. Inadequate amounts of data were available for dexibuprofen, dextropropoxyphene 130 mg, diflunisal 125 mg, etoricoxib 60 mg, fenbufen, and indometacin. Where there was adequate information for drug/dose combinations (at least 200 participants, in at least two studies), we defined the addition of four comparisons of typical size (400 participants in total) with zero effect as making the result potentially subject to publication bias and therefore unreliable. Reliable results were obtained for 46 drug/dose combinations in all painful postsurgical conditions; 45 in dental pain and 14 in other painful conditions. NNTs varied from about 1.5 to 20 for at least 50% maximum pain relief over four to six hours compared with placebo. The proportion of participants achieving this level of benefit varied from about 30% to over 70%, and the time to remedication varied from two hours (placebo) to over 20 hours in the same pain condition. Participants reporting at least one adverse event were few and generally no different between active drug and placebo, with a few exceptions, principally for aspirin and opioids. Drug/dose combinations with good (low) NNTs were ibuprofen 400 mg (2.5; 95% confidence interval (CI) 2.4 to 2.6), diclofenac 50 mg (2.7; 95% CI 2.4 to 3.0), etoricoxib 120 mg (1.9; 95% CI 1.7 to 2.1), codeine 60 mg + paracetamol 1000 mg (2.2; 95% CI 1.8 to 2.9), celecoxib 400 mg (2.5; 95% CI 2.2 to 2.9), and naproxen 500/550 mg (2.7; 95% CI 2.3 to 3.3). Long duration of action (8 hours) was found for etoricoxib 120 mg, diflunisal 500 mg, oxycodone 10 mg + paracetamol 650 mg, naproxen 500/550 mg, and celecoxib 400 mg. Not all participants had good pain relief and for many drug/dose combinations 50% or more did not achieve at last 50% maximum pain relief over four to six hours. There is a wealth of reliable evidence on the analgesic efficacy of single dose oral analgesics. There is also important information on drugs for which there are no data, inadequate data, or where results are unreliable due to susceptibility to publication bias. This should inform choices by professionals and consumers.