背景:临床医生定期开阿片类药物来治疗急性和慢性癌症疼痛,经常解决急性术后疼痛,偶尔治疗慢性非癌性疼痛。由于副作用和/或反应不良,某些患者的临床疗效可能欠佳。和阿片样物质的旋转/转换(转换)经常是必要的。尽管实践广泛,阿片类药物转化率在临床医生之间不一致,实践,和国家。因此,我们对阿片类药物转化研究进行了范围界定系统评价,为国际eDelphi指南提供信息.
方法:为了确保全面审查,我们在多个数据库中进行了系统的搜索(OVIDMedline,PsycINFO,Embase,EBM-Cochrane系统评价和注册试验数据库,LILACS,IMEMR,AIM,WPRIM)使用截至2022年6月发表的研究。此外,我们进行了手工和GoogleScholar搜索,以验证我们发现的完整性。我们的纳入标准包括随机和非随机研究,没有年龄限制,只有少数儿科研究确定。我们纳入了癌症研究,非癌症,急性,和慢性疼痛。根据多国癌症支持护理(MASCC)标准确定证据的水平和等级。
结果:我们的搜索产生了21,118份摘要,包括140项随机(RCT)和68项非随机(NRCT)临床试验。我们将这些结果与最近公布的转化率进行了比较。已发表的评论与本范围界定的系统评论之间存在适度的相关性。
结论:本范围系统评价发现低质量的证据支持阿片类药物转换指南。我们将使用这些数据,包括转化率、给药类型和途径,通知eDelphi指南。
BACKGROUND: Clinicians regularly prescribe opioids to manage acute and chronic cancer pain, frequently to address acute postoperative pain, and occasionally to manage chronic non-cancer pain. Clinical efficacy may be suboptimal in some patients due to side effects and/or poor response, and opioid rotation/switching (conversions) is frequently necessary. Despite the widespread practice, opioid conversion ratios are inconsistent between clinicians, practices, and countries. Therefore, we performed a scoping systematic review of opioid conversion studies to inform an international eDelphi guideline.
METHODS: To ensure a comprehensive review, we conducted a systematic search across multiple databases (OVID Medline, PsycINFO, Embase, EBM-Cochrane Database of Systematic Reviews and Registered Trials, LILACS, IMEMR, AIM, WPRIM) using studies published up to June 2022. Additionally, we performed hand and Google Scholar searches to verify the completeness of our findings. Our inclusion criteria encompassed randomized and non-randomized studies with no age limit, with only a few pediatric studies identified. We included studies on cancer, non-cancer, acute, and chronic pain. The level and grade of evidence were determined based on the Multinational Supportive Care in Cancer (MASCC) criteria.
RESULTS: Our search yielded 21,118 abstracts, including 140 randomized (RCT) and 68 non-randomized (NRCT) clinical trials. We compared these results with recently published conversion ratios. Modest correlations were noted between published reviews and the present scoping systematic review.
CONCLUSIONS: The present scoping systematic review found low-quality evidence to support an opioid conversion guideline. We will use these data, including conversion ratios and type and route of administration, to inform an eDelphi guideline.