PDF(Pubmed)
Abstract：
Background: Postoperative nausea and vomiting (PONV) is a common complication, that can reduce patient satisfaction and may lead to serious consequences, such as wound dehiscence. Many strategies have been proposed to prevent PONV; however, it remains common, especially in high-risk surgeries such as gynecological surgery. In recent years, opioid-free anesthesia has been widely studied because it minimizes adverse reactions of opioids, such as nausea, vomiting, and itching; however, conclusions have been inconsistent. Therefore, we conducted this meta-analysis to investigate the effects of opioid-free anesthesia on PONV in patients undergoing gynecological surgery. Methods: A systematic search of the PubMed, Web of Science, Cochrane Library, and Embase databases, from inception to 28 August 2023, was performed. Keywords and other free terms were used with Boolean operators (OR and, AND) to combine searches. This review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Six studies involving 514 patients who underwent gynecological surgery were included. The forest plot revealed that the incidence of PONV (risk ratio = 0.52; p < 0.00001) and consumption of postoperative antiemetics use (risk ratio = 0.64; p = 0.03) were significantly lower in the opioid-free anesthesia group. In addition, opioid-free anesthesia improved the quality of recovery (mean difference = 4.69; p < 0.0001). However, there were no significant differences in postoperative pain scores (mean difference = 0.05; p = 0.85), analgesic use (risk ratio = 1.09; p = 0.65), and the time of extubation (mean difference = -0.89; p = 0.09) between the opioid-free anesthesia and control groups. Conclusion: OFA reduces PONV and the use of antiemetic drugs. In addition, it improves the quality of postoperative recovery. However, OFA can not reduce the postoperative pain scores, analgesic use and the time of extubation. Due to the strength of the evidence, we cannot support OFA as an ideal anesthesia method in gynecological surgery, and the implementation of anesthesia strategies should be case-by-case. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=462044], identifier [CRD42023462044].
摘要：
背景：术后恶心和呕吐（PONV）是一种常见的并发症，这会降低患者满意度并可能导致严重后果，如伤口开裂。已经提出了许多策略来防止PONV；然而，它仍然很常见，特别是在高风险的手术，如妇科手术。近年来,无阿片类药物麻醉已被广泛研究，因为它可以最大限度地减少阿片类药物的不良反应，比如恶心，呕吐,和瘙痒；然而，结论不一致。因此,我们进行了这项荟萃分析,以探讨无阿片类药物麻醉对妇科手术患者PONV的影响.方法：系统搜索PubMed，WebofScience,科克伦图书馆,和Embase数据库，从成立到2023年8月28日，执行。关键词和其他自由项与布尔运算符一起使用(OR和，AND）结合搜索。本综述是根据系统评价和荟萃分析（PRISMA）的首选报告项目进行的。结果：纳入6项研究，涉及514例接受妇科手术的患者。森林图显示，在无阿片类药物麻醉组中，PONV的发生率（风险比=0.52;p<0.00001）和术后止吐药的使用（风险比=0.64;p=0.03）显着降低。此外,无阿片类药物麻醉改善了恢复质量（平均差异=4.69；p<0.0001）。然而,术后疼痛评分无显著差异(均差=0.05;p=0.85),镇痛药使用（风险比=1.09；p=0.65），无阿片类药物麻醉组和对照组的拔管时间（平均差=-0.89；p=0.09）。结论:OFA降低了PONV和止吐药物的使用。此外,提高了术后恢复质量。然而,OFA不能降低术后疼痛评分，镇痛的使用和拔管的时间。由于证据的力量,我们不能支持OFA作为妇科手术中理想的麻醉方法，麻醉策略的实施应根据具体情况进行。系统审查注册：[https://www。crd.约克。AC.uk/prospro/display_record.php?RecordID=462044],标识符[CRD42023462044]。
