Background:Managing acute postoperative pain is challenging for anesthesiologists,surgeons,and patients,leading to adverse events despite making significant progress.Patient-controlled intravenous analgesia(PCIA)is a ...Background:Managing acute postoperative pain is challenging for anesthesiologists,surgeons,and patients,leading to adverse events despite making significant progress.Patient-controlled intravenous analgesia(PCIA)is a recommended solution,where oxycodone has depicted unique advantages in recent years.However,controversy still exists in clinical practice and this study aimed to compare two drugs in PCIA.Methods:We performed a literature search in PubMed,Embase,the Cochrane Central Register of Controlled Trials,Web of Science,Chinese National Knowledge Infrastructure,Wanfang,and VIP databases up to December 2020 to select specific randomized controlled trials(RCTs)comparing the efficacy of oxycodone with sufentanil in PCIA.The analgesic effect was the primary outcome and the secondary outcome included PCIA consumption,the Ramsay sedation scale,patients’satisfaction and side effects.Results:Fifteen RCTs were included in the meta-analysis.Compared with sufentanil,oxycodone showed lower Numerical Rating Scale scores(mean difference[MD]=-0.71,95%confidence interval[CI]:-1.01 to-0.41;P<0.001;I^(2)=93%),demonstrated better relief from visceral pain(MD=-1.22,95%CI:-1.58 to-0.85;P<0.001;I^(2)=90%),promoted a deeper sedative level as confirmed by the Ramsay Score(MD=0.77,95%CI:0.35-1.19;P<0.001;I^(2)=97%),and resulted in fewer side effects(odds ratio[OR]=0.46,95%CI:0.35-0.60;P<0.001;I^(2)=11%).There was no statistical difference in the degree of patients'satisfaction(OR=1.13,95%CI:0.88-1.44;P=0.33;I^(2)=72%)and drug consumption(MD=-5.55,95%CI:-14.18 to 3.08;P=0.21;I^(2)=93%).Conclusion:Oxycodone improves postoperative analgesia and causes fewer adverse effects,and could be recommended for PCIA,especially after abdominal surgeries.Registration:PROSPERO;https://www.crd.york.ac.uk/PROSPERO/;CRD42021229973.展开更多
Owing to the advances in surgical technology,most solid tumours can be controlled by surgical excision.The priority should be tumour control,while some routine perioperative management might influence cancer progressi...Owing to the advances in surgical technology,most solid tumours can be controlled by surgical excision.The priority should be tumour control,while some routine perioperative management might influence cancer progression in an unnoticed way.Moreover,it is increasingly recognized that effective perioperative management should include techniques to improve postoperative outcomes.These influences are elucidated by the different functions of circulating biomarkers in cancer patients.Here,circulating biomarkers with two types of clinical functions were reviewed:(i)circulating biomarkers for cancer progression monitoring,for instance,those related to cancer cell malignancy,tumour microenvironment formation,and early metastasis,and(i)circulating biomarkers with relevance to postoperative outcomes,including systemic inflammation,immunosuppression,cognitive dysfunction,and pain management.This review aimed to provide new perspectives for the perioperative management of patients with cancer and highlight the potential clinical translation value of circulating biomarkers in improving outcomes.展开更多
文摘Background:Managing acute postoperative pain is challenging for anesthesiologists,surgeons,and patients,leading to adverse events despite making significant progress.Patient-controlled intravenous analgesia(PCIA)is a recommended solution,where oxycodone has depicted unique advantages in recent years.However,controversy still exists in clinical practice and this study aimed to compare two drugs in PCIA.Methods:We performed a literature search in PubMed,Embase,the Cochrane Central Register of Controlled Trials,Web of Science,Chinese National Knowledge Infrastructure,Wanfang,and VIP databases up to December 2020 to select specific randomized controlled trials(RCTs)comparing the efficacy of oxycodone with sufentanil in PCIA.The analgesic effect was the primary outcome and the secondary outcome included PCIA consumption,the Ramsay sedation scale,patients’satisfaction and side effects.Results:Fifteen RCTs were included in the meta-analysis.Compared with sufentanil,oxycodone showed lower Numerical Rating Scale scores(mean difference[MD]=-0.71,95%confidence interval[CI]:-1.01 to-0.41;P<0.001;I^(2)=93%),demonstrated better relief from visceral pain(MD=-1.22,95%CI:-1.58 to-0.85;P<0.001;I^(2)=90%),promoted a deeper sedative level as confirmed by the Ramsay Score(MD=0.77,95%CI:0.35-1.19;P<0.001;I^(2)=97%),and resulted in fewer side effects(odds ratio[OR]=0.46,95%CI:0.35-0.60;P<0.001;I^(2)=11%).There was no statistical difference in the degree of patients'satisfaction(OR=1.13,95%CI:0.88-1.44;P=0.33;I^(2)=72%)and drug consumption(MD=-5.55,95%CI:-14.18 to 3.08;P=0.21;I^(2)=93%).Conclusion:Oxycodone improves postoperative analgesia and causes fewer adverse effects,and could be recommended for PCIA,especially after abdominal surgeries.Registration:PROSPERO;https://www.crd.york.ac.uk/PROSPERO/;CRD42021229973.
基金supported by the National Key Research and Development Program of China(Grant No.2018YFC2001800)to X.H.and T.Z.Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(Grant No.2019-12M-5-011)to T.Z.
文摘Owing to the advances in surgical technology,most solid tumours can be controlled by surgical excision.The priority should be tumour control,while some routine perioperative management might influence cancer progression in an unnoticed way.Moreover,it is increasingly recognized that effective perioperative management should include techniques to improve postoperative outcomes.These influences are elucidated by the different functions of circulating biomarkers in cancer patients.Here,circulating biomarkers with two types of clinical functions were reviewed:(i)circulating biomarkers for cancer progression monitoring,for instance,those related to cancer cell malignancy,tumour microenvironment formation,and early metastasis,and(i)circulating biomarkers with relevance to postoperative outcomes,including systemic inflammation,immunosuppression,cognitive dysfunction,and pain management.This review aimed to provide new perspectives for the perioperative management of patients with cancer and highlight the potential clinical translation value of circulating biomarkers in improving outcomes.
