First do no harm: pain relief for the peripheral venous cannulation of adults, a systematic review and network meta-analysis
First do no harm: pain relief for the peripheral venous cannulation of adults, a systematic review and network meta-analysis
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DOI：
10.1186/s12871-016-0252-8
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发表时间：
2016-10-01
影响因子：
2.2
通讯作者：
Powell, Roy
中科院分区：
文献类型：
--
作者：
Bond, Mary;Crathorne, Louise;Powell, Roy
背景：外周静脉插管是医院的日常操作，许多成年人觉得很痛苦。然而，插管麻醉通常只提供给儿童。疼痛缓解不足不仅会让患者感到不愉快，还可能导致患者对进一步治疗感到焦虑，并阻止患者在未来寻求医疗护理。本研究的目的是探索成人外周静脉插管中最有效的局部麻醉药，并比较局部麻醉药应用与未减毒插管的疼痛。方法：通过系统综述、网络荟萃分析和随机效应荟萃分析来解决这些目标。检索涵盖MEDLINE、EMBASE等12个数据库，检索时间为1990年至2015年8月。主要纳入的研究设计为随机对照试验。主要结果测量是自我报告的疼痛，用100毫米视觉模拟量表测量。结果：系统评价共纳入37项研究，其中27项适合网络荟萃分析，2项适合随机效应荟萃分析。网络荟萃分析的结果表明，17种麻醉药中没有一种在相互比较时具有非常高的最有效概率；2%利多卡因的发生率最高（44%）。当将麻醉与未治疗进行比较时，网络荟萃分析再次显示2%利多卡因估计最有效(平均差值- 25.42 （95% CI -32.25, -18.57）。据估计，“凯恩”家族的其他成员也比不治疗更有效，如Ametop (R)、EMLA (R)和Rapydan (R)贴片。meta分析比较了麻醉应用的疼痛和未减轻的插管疼痛。结果发现，所有局部麻醉的应用都比没有局部麻醉的插管疼痛要小。特别是1%利多卡因注射估计比未减毒插管疼痛减轻- 12.97 （95% CI -15.71, -10.24）点（100 mm VAS）。结论：成人外周静脉置管疼痛是可以成功治疗的。应用任何局部麻醉剂的疼痛都比未减毒插管的疼痛小。插管前的局部麻醉应成为常规做法和高质量护理的标志。
Background: Peripheral venous cannulation is an everyday practice in hospitals, which many adults find painful. However, anaesthesia for cannulation is usually only offered to children. Inadequate pain relief is not only unpleasant for patients but may cause anxiety about further treatment and deter patients from seeking medical care in the future. The aim of this study is to discover the most effective local anaesthetic for adult peripheral venous cannulation and to find out how the pain of local anaesthetic application compares with that of unattenuated cannulation.Methods: These aims are addressed through a systematic review, network meta-analysis and random-effects meta-analysis. Searching covered 12 databases including MEDLINE and EMBASE from 1990 to August 2015. The main included study design was RCTs. The primary outcome measure is self-reported pain, measured on a 100 mm visual analogue scale.Results: The systematic review found 37 includable studies, 27 of which were suitable for network meta-analysis and two for random-effects meta-analysis. The results of the network meta-analysis indicate that none of the 17 anaesthetic considered had a very high probability of being the most effective when compared to each other; 2 % lidocaine had the highest probability (44 %). When the anaesthetics were compared to no treatment, the network meta-analysis showed that again 2 % lidocaine was estimated to be the most effective (mean difference - 25.42 (95 % CI -32.25, -18.57). Other members of the 'caine' family were also estimated to be more effective than no treatment as were Ametop (R), EMLA (R) and Rapydan (R) patch. The meta-analysis compared the pain of anaesthetic application with the unattenuated pain of cannulation. This found that all applications of local anaesthetic were less painful than cannulation without local anaesthetic. In particular a 1 % lidocaine injection was estimated to be - 12.97 (95 % CI -15.71, -10.24) points (100 mm VAS) less painful than unattenuated cannulation.Conclusions: The pain of peripheral venous cannulation in adults can be successfully treated. The pain of application of any local anaesthetic is less than that of unattenuated cannulation. Local anaesthetic prior to cannulation should become normal practice and a marker of high quality care.