非甾体类抗炎药物在小儿术后疼痛中应用的荟萃分析

背景在儿童术后期间，阿片类药物的副作用是一个人们极为关注的问题。现已证明非甾体抗炎药（nonsteroidal antiinflammatory drugs，NSAIDs）能够有效地减少术后疼痛，但是其阿片药物节省效应仍存在争议。在这篇荟萃分析中，我们针对儿童对NSAIDs的术后阿片药物节省效应进行了调查研究。方法通过进行全面的文献检索，以确定在儿童和婴儿中使用NSAIDs和阿片类药物作为围术期镇痛复合物的临床试验。测量指标为阿片类药物用量、疼痛程度、术后恶心呕吐（postoperative nausea and vomiting，PONV）和尿潴留。我们对在麻醉恢复室（postanesthesiacareunit，PACU）期间和术后第一个24小时的所有结果进行了研究。将每个试验的数据结合起来计算合并比值比（oddsratios，ORs）或标准化均数差（standardized mean difference，SMD）及其95％可信区间。结果分析27个随机对照研究。围术期给予NSAIDs能够减少术后阿片类药物的需求[在PACU和术后第一个刀小时期间；SMD分别为-0．66（-0．84，-0．48）和-0．83（-1.11，-0．55）]、在PACU的疼痛程度[SMD=-0．85（-1.24,-0．47）]和术后第一个刀小时期间的PONV[OR=0．75（0．57—0．99）]。NSAIDs不能降低术后第一个刀小时期间的疼痛程度[OR=0．56（0．26-1.2）]和PACU停留期间的PONV[OR=J．02（0．73-1.44）]。根据非甾体抗炎药的给予时间（术中与术后）、手术类型和与对乙酰氨基酚合用来进行亚组分析，分析结果表明：除了合用对乙酰氨基酚与手术类型能够分别降低术后第一个24小时内的疼痛程度和PONV的发生率以外，其他因素对研究结果并无影响。结论这一荟萃分析表明，围术期给予NSAID可减少儿童术后阿片类药物的用量和PONV。

BACKGROUND： Opioid side effects are a great concern during the postoperative period in children. Nonsteroidal antiinflammatory drugs （NSAIDs） have been shown to effectively decrease postoperative pain, but their opioid- sparing effect is still controversial. In this present metaanalysis, we investigated the postoperative opioid-sparing effect of NSAIDs in children. METHODS： A comprehensive literature search was conducted to identify clinical trials using NSAIDs and opioids as perioperative analgesic compounds in children and infants. Outcomes measured were opioid consumption, pain intensity, postoperative nausea and vomiting （PONV）, and urinary retention. All outcomes were studied during postanesthesia care unit （PACU） stay and the first 24 postoperative hours. Data from each trial were combined to calculate the pooled odds ratios （ORs） or standardized mean difference （SMD） and their 95% confidence interval. RESULTS： Twenty-seven randomized controlled studies were analyzed. Perioperative administration of NSAIDs decreased postoperative opioid requirement （both in the PACU and during the first 24 postoperative hours; SMD = - 0. 66 [ - 0. 84, - 0. 48 3 and - 0. 83 [ - 1. i1, - 0. 55 ], respectively）, pain intensity in the PACU （SMD = - 0. 85 [ - 1.24, - 0. 473）, and PONV during the first 24 postoperative hours （OR = 0. 75 [0. 57 -0. 99] 1）. NSAIDs did not decrease pain intensity during the first 24 postoperative hours （OR = 0.56 [0.26 -1.21） and PONV during PACU stay （OR = 1.02 [0. 73 - 1.44]）. Subgroup analysis according to the timing of NSAID administration （intraoperative versus postoperative）, type of surgery, or coadministration of paracetamol did not show any influence of these factors on the studied outcomes except the reduction of pain intensity and the incidence of PONV during the first 24 postoperative hours, which were influenced by the coadministration of paracetamol and the type of surgery, respectively. CONCLUSIONS： This meta-analysis shows that perioperative NSAID administration reducesopioidconsumption and PONV during the postoperative period in children.