未经证实:骨科手术后疼痛是一个严重的问题,通常需要服用镇痛药;然而,镇痛的最佳给药时间仍不确定。围手术期镇痛是在手术前和手术期间进行先发制人的镇痛,然后进行术后镇痛,以减少与手术相关的伤害性反应。我们旨在评估围手术期美洛昔康与术后美洛昔康对骨科手术后疼痛控制的影响。
UNASSIGNED:涉及PubMed随机对照试验的系统评价和荟萃分析,Embase,Scopus,WOS,和Cochrane直到2022年5月28日。我们使用以95%置信区间(CI)表示的风险比(RR)和使用平均差异(MD)以95%CI表示的连续结果进行汇总。我们在PROSPERO中注册了我们的协议,ID为CRD42022336046。
未经授权:我们纳入了5个RCT,共964名患者。所有纳入的试验显示,由于缺乏盲法,性能和检测偏差的风险很高。汇总分析有利于围手术期美洛昔康降低6小时后疼痛评分(MD:-0.42,95%CI[-0.63,-0.21],p=.0001),12小时(MD:-0.54,95%CI[-0.69,-0.39],p=.00001),和24小时(MD:-0.23,95%CI[-0.36,-0.10]。汇总分析有利于围手术期美洛昔康在12小时后改善患者总体评估量表(MD:-0.66,95%CI[-0.86,-0.46],p=.00001),24小时(MD:-0.30,95%CI[-0.49,-0.11,p=0.002),和48小时(MD:-0.17,95%CI[-0.33,-0.01],p=.04)。汇总分析有利于围手术期美洛昔康减少患者自控镇痛(MD:-4.25,95%CI[-5.96,-2.54],p=.00001)。
UNASSIGNED:围手术期美洛昔康比术后美洛昔康更好地完成骨科手术后的短期疼痛管理。在骨科手术后推荐围手术期美洛昔康进行疼痛控制之前,仍需要进一步的多中心试验来研究美洛昔康在不同骨科手术围手术期的影响.
Post-orthopaedic operative pain is a serious concern that often requires the administration of analgesics; however, the optimal time of analgesic administration is still inconclusive. Perioperative analgesia is administrating pre-emptive analgesia before and during the surgery followed by postoperative analgesia to decrease the procedure associated nociceptive response. We aim to assess perioperative
meloxicam versus postoperative
meloxicam for pain control after orthopaedic operations.
A systematic
review and meta-analysis involving randomized controlled trials from PubMed, Embase, Scopus, WOS, and Cochrane until 28th May 2022. We pooled dichotomous outcomes using risk ratio (RR) presented with a 95% confidence interval (CI) and continuous outcomes using mean difference (MD) with 95% CI. We registered our protocol in PROSPERO with ID: CRD42022336046.
We included five RCTs with 964 patients. All the included trials showed high risk of performance and detection biases because of lack of blinding. Pooled analysis favored perioperative
meloxicam in reducing pain score after six hours (MD: -0.42 with 95% CI [-0.63, -0.21], p = .0001), 12 h (MD: -0.54 with 95% CI [-0.69, -0.39], p = .00001), and 24 h (MD: -0.23 with 95% CI [-0.36, -0.10]. Pooled analysis favored perioperative
meloxicam in improving patient global assessment scale after 12 h (MD: -0.66 with 95% CI [-0.86, -0.46], p = .00001), 24 h (MD: -0.30 with 95% CI [-0.49, -0.11, p = .002), and 48 h (MD: -0.17 with 95% CI [-0.33, -0.01], p = .04). Pooled analysis favored perioperative meloxicam in reducing patient-controlled analgesia (MD: -4.25 with 95% CI [-5.96, -2.54], p = .00001).
Short-term pain management after orthopaedic procedures is better accomplished with perioperative meloxicam than postoperative
meloxicam. Before recommending perioperative meloxicam for pain control following orthopaedic surgeries, further multicentre trials are still warranted to examine the impact of perioperative meloxicam in different orthopaedic procedures.