Analgesic Effects of Locally Administered Ketorolac-based Analgesics After Breast Surgery: A Meta-Analysis of Randomized Controlled Trials
Analgesic Effects of Locally Administered Ketorolac-based Analgesics After Breast Surgery: A Meta-Analysis of Randomized Controlled Trials
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乳房手术后局部使用酮咯酸镇痛药的镇痛效果：随机对照试验的荟萃分析
DOI：
10.1097/ajp.0000000000000556
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
K. Tam
中科院分区：
文献类型：
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作者：
Jen;I. Feng;E. Loh;Li;Chao;K. Tam
目的：减少乳房手术后疼痛对快速恢复和缩短住院时间至关重要。酮咯酸是一种非甾体抗炎药，在许多外科手术中用作术后镇痛药。我们对局部使用酮罗拉酸镇痛药治疗乳房手术后疼痛的疗效进行了系统回顾和荟萃分析。方法：我们检索PubMed、Embase、Cochrane Library、Scopus和ClinicalTrials.gov注册库，检索截至2016年9月发表的随机对照试验（rct）。主要结局是在乳房手术后1和6小时使用视觉模拟评分（VAS）评估疼痛水平。结果：我们回顾了4项随机对照试验，共255例患者。meta分析比较了3个相似随机对照试验1和6小时的VAS。在1小时时，给予酮洛酸溶液的患者VAS评分显著降低[加权平均差(WMD)=−2.04；95%置信区间（CI）：−3.08至−1.00]或酮酸布比卡因溶液（WMD=−2.30;95% CI,−4.07至−0.54）较对照组显著增加。6小时时，与对照组相比，酮咯酸-布比卡因溶液显著降低VAS评分（WMD= - 1.40; 95% CI, - 2.48至- 0.32）。然而，在1小时时，酮咯酸溶液明显比布比卡因溶液更有效（WMD= - 1.70; 95% CI, - 2.81至- 0.59）。讨论：酮酸镇痛药的效果因手术和疾病类型而异。局部给予酮罗拉酸类镇痛药可减轻乳房手术患者术后疼痛，且局部给予酮罗拉酸的效果优于局部使用布比卡因。因此，酮咯酸类镇痛药在乳房手术后疼痛管理中表现出相当大的局部浸润。
Objective: Reducing postoperative pain following breast surgery is crucial for rapid recovery and shortening hospital stay. Ketorolac, a nonsteroidal anti-inflammatory drug, has been used as a postoperative analgesic in many surgical procedures. We conducted a systemic review and meta-analysis on the efficacy of locally administered ketorolac-based analgesics in managing pain after breast surgery. Methods: We searched the PubMed, Embase, Cochrane Library, Scopus, and ClinicalTrials.gov registry for randomized control trials (RCTs) published up to September 2016. The primary outcome was pain level assessed using a visual analog scale (VAS) at 1 and 6 hours following breast surgery. Results: We reviewed 4 RCTs with 255 patients. For meta-analysis, VAS at 1 and 6 hours of 3 similar RCTs were compared. At 1 hour, VAS scores were significantly lower in patients administered a ketorolac solution [weighted mean difference (WMD)=−2.04; 95% confidence interval (CI): −3.08 to −1.00] or ketorolac-bupivacaine solution (WMD=−2.30; 95% CI, −4.07 to −0.54) than in controls. At 6 hours, the ketorolac-bupivacaine solution reduced VAS scores significantly (WMD=−1.40; 95% CI, −2.48 to −0.32) compared with controls. However, at 1 hour, the ketorolac solution was significantly more effective than the bupivacaine solution was (WMD=−1.70; 95% CI, −2.81 to −0.59). Discussion: The effects of ketorolac-based analgesics vary as per the surgery and disease type. Locally administered ketorolac-based analgesics decreased postoperative pain in breast surgery patients, and the effect of local ketorolac was better than local bupivacaine. Therefore, ketorolac-based analgesics demonstrate considerable local infiltration during pain management after breast surgery.