Postoperative Pain in Vitreoretinal Surgery With Combined Regional-General Anesthesia Versus General Anesthesia: A Systematic Review and Meta-Analysis

IF 4.1 1区 医学 Q1 OPHTHALMOLOGY American Journal of Ophthalmology Pub Date : 2024-11-05 DOI:10.1016/j.ajo.2024.10.032
Yu-Chen Su , Yu-Chi Su , Sheng-Min Hsu
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Abstract

Purpose

To investigate postoperative pain variations in vitreoretinal surgeries conducted with combined regional-general anesthesia or general anesthesia.

Design

Systematic review and meta-analysis.

Methods

A systematic search of the PubMed, Embase, and Cochrane Library databases was conducted to identify relevant randomized controlled trials published before December 26, 2023. Studies comparing vitreoretinal surgeries conducted under combined anesthesia to general anesthesia were included, while studies using only regional anesthesia were excluded. The quality of the studies was assessed using the Cochrane Collaboration risk of bias tool, and the results are presented as odds ratios or standardized mean differences (SMDs) with 95% confidence intervals (CIs). I2 statistic was calculated to assess heterogeneity. The primary outcomes in our study included the proportions of patients needing as-needed postoperative analgesics, dosage of as-needed postoperative analgesia medications, and time to the first demand for as-needed postoperative analgesia. The secondary outcomes included postoperative pain scores at 0.5, 1, 2, 4, 6, 12, 24 hours (h), duration of surgery and anesthesia, and percentage of patients experiencing postoperative nausea and vomiting.

Results

A total of 19 randomized controlled trials involving 1314 patients were analyzed. Combined anesthesia was associated with lower proportions of patients needing as-needed postoperative analgesics (odds ratio, 0.218 95% CI, 0.114-0.418, I2 = 55.2%), reduced dosage of as-needed postoperative analgesia medications (SMD, –1.429, 95% CI, –2.395 to –0.462, I2 = 90.4%), and longer time to the first demand for as-needed postoperative analgesia compared with general anesthesia alone (SMD, 2.650, 95% CI, 1.169-4.132, I2 = 96.5%). The effect of additional regional anesthesia lasted for 6 h (0.5 h SMD, –1.471, 95% CI, –2.498 to –0.444, I2 = 90.5%; 1 h, –1.507, –2.309 to –0.705, 92.7%; 2 h –1.487, –2.300 to –0.674, 93.2%; 4 h –1.052, –1.708 to –0.396, 89.5%; 6 h –1.053, –1.932 to –0.174, 93.4%; 12 h –0.286, –0.648 to 0.076, 57.1%; 24 h –0.297, –0.624 to 0.029, 64.0%). Combined anesthesia decreased postoperative nausea and vomiting risk without affecting the surgical or anesthesia duration.

Conclusions

Combined anesthesia demonstrated additional postoperative analgesic effects versus general anesthesia only. Further research is needed to validate the results of our study and to identify vision-threatening complications.
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玻璃体视网膜手术中的术后疼痛:联合区域-全身麻醉与全身麻醉:系统回顾与元分析》。
目的:研究采用区域-全身联合麻醉或全身麻醉进行玻璃体视网膜手术的术后疼痛变化:方法:系统综述和荟萃分析:对PubMed、Embase和Cochrane图书馆数据库进行系统检索,以确定2023年12月26日之前发表的相关随机对照试验(RCT)。纳入了在联合麻醉和全身麻醉下进行玻璃体视网膜手术的比较研究,同时排除了仅使用区域麻醉的研究。研究质量采用 Cochrane 协作偏倚风险工具进行评估,结果以几率比(OR)或标准化平均差(SMD)及 95% 置信区间(CI)表示。I2统计量用于评估异质性。我们研究的主要结果包括需要术后必要镇痛药物的患者比例、术后必要镇痛药物的剂量以及首次需要术后必要镇痛药物的时间。次要结果包括术后 0.5、1、2、4、6、12 和 24 小时(h)的疼痛评分、手术和麻醉持续时间以及术后恶心和呕吐(PONV)患者的百分比:结果:共分析了 19 项 RCT,涉及 1314 名患者。联合麻醉与需要术后镇痛药的患者比例降低(OR, 0.218 95% CI, 0.114 to 0.418, I2 = 55.2%)、术后镇痛药剂量减少(SMD, -1.429,95% CI,-2.395 至 -0.462,I2 = 90.4%),与单纯全身麻醉相比,首次要求术后镇痛的时间更长(SMD,2.650,95% CI,1.169 至 4.132,I2 = 96.5%)。额外区域麻醉的效果持续了 6 个小时(0.5 小时 SMD,-1.471,95% CI,-2.498 至 -0.444,I2 = 90.5%;1 小时,-1.507,-2.309 至 -0.705,92.7%;2 小时,-1.487,-2.300 至 -0.674,93.2%;4h -1.052,-1.708 至 -0.396,89.5%;6h -1.053,-1.932 至 -0.174,93.4%;12h -0.286,-0.648 至 0.076,57.1%;24h -0.297,-0.624 至 0.029,64.0%)。联合麻醉降低了PONV风险,但不影响手术或麻醉持续时间:结论:与单纯全身麻醉相比,联合麻醉具有额外的术后镇痛效果。需要进一步研究来验证我们的研究结果,并确定威胁视力的并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
9.20
自引率
7.10%
发文量
406
审稿时长
36 days
期刊介绍: The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.
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