芬太尼离子透皮系统治疗术后疼痛疗效meta分析

Keah-How Poon , Kian-Hian Tan , Kok-Yuen Ho
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引用次数: 5

摘要

背景:术后镇痛方式包括多种途径的患者控制技术,如静脉注射和硬膜外注射。使用离子透皮技术的透皮给药途径看起来很有前景。最近的随机对照试验表明,芬太尼离子吸入性透皮系统(ITS)与静脉注射吗啡患者自控镇痛(PCA)的疗效相当。本荟萃分析的目的是评估该系统在急性术后疼痛管理中的有效性和安全性。方法根据QUOROM指南对满足纳入标准的2项安慰剂对照和4项主动对照随机试验进行meta分析。结果芬太尼ITS在术后镇痛方面优于安慰剂,以疼痛评分作为预后指标。当患者整体评估作为主要结果测量时,芬太尼ITS与吗啡PCA相当。然而,芬太尼ITS组因镇痛不足而退出治疗的患者明显更多。这可能与芬太尼ITS的药代动力学特征有关。副作用和安全性似乎是有利的。结论芬太尼ITS是一种有前景的新型术后镇痛方式,优于安慰剂,但可能不等同于吗啡PCA,正如个别试验和最近的综述所声称的那样。它的使用似乎是安全的。
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Efficacy of fentanyl iontophoretic transdermal system in postoperative pain—A meta-analysis

Background

Postoperative analgesic modalities include patient-controlled techniques via various routes such as intravenous and epidural. A transdermal delivery route using iontophoretic technology appears promising. Recent randomised controlled trials have suggested that fentanyl iontophoretic transdermal system (ITS) was of equivalent efficacy to intravenous morphine patient-controlled analgesia (PCA). The objective of this meta-analysis was to assess the efficacy and safety of this system in the management of acute postoperative pain.

Methods

A meta-analysis of two placebo-controlled and four active-controlled randomised trials which satisfied the inclusion criteria was performed according to the QUOROM guidelines.

Results

Fentanyl ITS was superior to placebo for postoperative analgesia using withdrawal secondary to inadequate analgesia and pain scores as outcome measures. Fentanyl ITS was equivalent to morphine PCA when Patient Global Assessment was used as primary outcome measure. However, there were significantly more patients in the fentanyl ITS group who withdrew due to inadequate analgesia. This may be related to the pharmacokinetic profile of fentanyl ITS. Adverse effect and safety profile seemed favourable.

Conclusions

Fentanyl ITS is a promising novel modality for postoperative analgesia that is superior to placebo but may not be equivalent to morphine PCA as claimed by individual trials and recent reviews. Its use appears to be safe.

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Conference Calendar Editorial Board Announcement Anaesthesiologist-associated risk factors for inadequate postoperative pain management Continuing use of droperidol in patient-controlled analgesia with morphine
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