地塞米松对成人扁桃体切除术后疼痛与镇痛药物影响的系统评价
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Systematic review on analgesics and dexamethasone for
posttonsillectomy pain in adults
背景与目的
扁桃体切除术后疼痛通常会持续几天。由于治疗经验不足，因此尚需要探讨改进的镇痛策略以便于患者可以安全地在家使用。
方 法
本研究对使用全身性药物治疗扁桃体切除术后疼痛的成人和青少年（13岁）患者的疗效进行了系统回顾和荟萃分析；检索PubMed，Cochrane等数据库等相关文献并从待研究文章中检索相关参考文献，纳入报告疼痛强度或使用镇痛药物在内的随机、双盲、安慰剂对照试验。
结 果
共纳入符合入选标准的29个随机对照试验，共1816名受试者。其中15项研究的随访时间为24小时，大多数服用非甾体类抗炎药。13项研究适合进行荟萃分析，综合分析中，对乙酰氨基酚、地塞米松和加巴喷丁类药物降低了手术当天的疼痛强度；分层分析研究中，酮洛芬、布洛芬、氯诺昔康、帕累克西布、罗非昔布、吲哚美辛和右美沙芬在手术当天减轻疼痛强度、但需要镇痛药使用。术后2周口服塞来昔布或手术当天静脉注射氯胺酮无明显术后疼痛治疗效果。多种剂量地塞米松术后镇痛效果均超过1d.术后第一周，研究组和对照组的疼痛均为中度至重度。
结 论
单一镇痛药物和地塞米松仅对术后扁桃体切除术后疼痛有弱到中度的作用，因此建议采用多模式镇痛策略。本研究受随访时间短和临床研究的异质性限制了结果的有效性。
原始文献摘要
H.K.Tolska, K Hamunen, A.Takala,etal;Systematic review on analgesics and dexamethasone for posttonsillectomy pain in adults;British Journal of Anaesthesia, xxx (xxx): xxx (xxxx);doi: 10.1016/j.bja.2019.04.063.
Background: Intense pain can last several days after tonsillectomy. It is often undertreated and improved analgesic strategies that can be safely used at home are needed.
Methods: We conducted a systematic review and meta-analysis on the effectiveness of systemic medications used for post-tonsillectomy pain in adult and adolescent (13 yr old) patients. Studies were identified from PubMed, the Cochrane Library, and by hand searching reference lists from studies and review articles. Randomised, double-blind, placebocontrolled studies reporting on pain intensity or use of rescue analgesia were included.
Results: Twenty-nine randomised controlled trials representing 1816 subjects met the inclusion criteria. Follow-up time was 24 h in 15 studies, in which the majority were taking nonsteroidal anti-inflammatory drugs. Thirteen studies were suitable for meta-analysis. In pooled analysis, paracetamol, dexamethasone, and gabapentinoids reduced pain intensity on the day of operation. In individual studies, ketoprofen, ibuprofen, lornoxicam, parecoxib, rofecoxib, indomethacin and
dextromethorphan reduced pain intensity, need for rescue analgesics, or both on the day of operation. Oral celecoxib for 2 postoperative weeks or i.v. ketamine on the day of operation were not effective at the studied doses. Dexamethasone in multiple doses provided analgesia beyond 1 postoperative day. Pain was moderate to strong in both study and control groups during the first postoperative week.
Conclusions: Single analgesics and dexamethasone provide only a weak to moderate effect for post-tonsillectomy pain on the day of operation and thus a multimodal analgesic strategy is recommended. Short follow-up times and clinical heterogeneity of studies limit the usefulness of results.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：王贵龙 编辑：何幼芹 审校：王贵龙