Effect of Perioperative Systemic α2 Agonists on Postoperative Morphine Consumption and Pain Intensity Systematic Review and Meta-analysis of Randomized Controlled Trials
Effect of Perioperative Systemic α2 Agonists on Postoperative Morphine Consumption and Pain Intensity Systematic Review and Meta-analysis of Randomized Controlled Trials
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DOI：
10.1097/aln.0b013e31825681cb
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发表时间：
2012-06-01
期刊：
影响因子：
8.8
通讯作者：
Tramer, Martin R.
中科院分区：
文献类型：
--
作者：
Blaudszun, Gregoire;Lysakowski, Christopher;Tramer, Martin R.
背景资料：全身α 2受体激动剂被认为可以减少疼痛和阿片类药物的需求手术后，从而降低阿片类药物相关的不良反应，包括hyperalgesia.Methods的发病率：作者搜索随机安慰剂对照试验测试全身α 2受体激动剂管理手术患者和报告术后累积阿片类药物的消耗和/或疼痛强度。当数据来自5个或更多的试验和/或100个或更多的patients could be combined.Results：30个研究（1,792例患者，933例接受可乐定或右美托咪定）被纳入。有证据表明术后24小时吗啡用量减少;可乐定组的加权平均差异为-4.1 mg（95%置信区间，-6.0至-2.2），右美托咪定组为-14.5 mg（-22.1至-6.8）。也有证据表明24 h时疼痛强度降低;可乐定组10 cm视觉模拟量表的加权平均差异为-0.7 cm（-1.2至-0.1），右美托咪定组为-0.6 cm（-0.9至-0.2）。早期恶心的发生率都降低了（需要治疗的人数约为9人）。可乐定增加了术中（需要伤害的人数，约9人）和术后低血压（需要伤害的人数，20人）的风险。右美托咪定增加了术后心动过缓的风险（需要伤害的数量，3）。恢复时间未延长。没有试验报道慢性疼痛或hyperalgesia.Conclusions：围手术期全身α 2受体激动剂减少术后阿片类药物的消耗，疼痛强度和恶心。恢复时间不会延长。常见的不良反应是心动过缓和动脉低血压。α 2受体激动剂对慢性疼痛或痛觉过敏的影响尚不清楚，因为缺乏有效的数据。
Background: Systemic alpha 2 agonists are believed to reduce pain and opioid requirements after surgery, thus decreasing the incidence of opioid-related adverse effects, including hyperalgesia.Methods: The authors searched for randomized placebo-controlled trials testing systemic alpha 2 agonists administrated in surgical patients and reporting on postoperative cumulative opioid consumption and/or pain intensity. Meta-analyses were performed when data from 5 or more trials and/or 100 or more patients could be combined.Results: Thirty studies (1,792 patients, 933 received clonidine or dexmedetomidine) were included. There was evidence of postoperative morphine-sparing at 24 h; the weighted mean difference was -4.1 mg (95% confidence interval, -6.0 to -2.2) with clonidine and -14.5 mg (-22.1 to -6.8) with dexmedetomidine. There was also evidence of a decrease in pain intensity at 24 h; the weighted mean difference was -0.7 cm (-1.2 to -0.1) on a 10-cm visual analog scale with clonidine and -0.6 cm (-0.9 to -0.2) with dexmedetomidine. The incidence of early nausea was decreased with both (number needed to treat, approximately nine). Clonidine increased the risk of intraoperative (number needed to harm, approximately nine) and postoperative hypotension (number needed to harm, 20). Dexmedetomidine increased the risk of postoperative bradycardia (number needed to harm, three). Recovery times were not prolonged. No trial reported on chronic pain or hyperalgesia.Conclusions: Perioperative systemic alpha 2 agonists decrease postoperative opioid consumption, pain intensity, and nausea. Recovery times are not prolonged. Common adverse effects are bradycardia and arterial hypotension. The impact of alpha 2 agonists on chronic pain or hyperalgesia remains unclear because valid data are lacking.