Pain management in acute musculoskeletal injury: Effect of opioid vs nonopioid medications  

作　　者：Marco Fiore Luigi Aurelio Nasto Eleni McCaffery Fannia Barletta Angela Visconti Francesca Gargano Enrico Pola Maria Caterina Pace 

机构地区：[1]Department of Women,Child and General and Specialized Surgery,University of Campania“Luigi Vanvitelli”,Naples 80138,Italy [2]Department of Orthopaedics,University of Campania“Luigi Vanvitelli”,Naples 80138,Italy [3]Department of Emergency Medicine,New York Presbyterian-Brooklyn Methodist Hospital,New York,NY 11215,United States [4]Department of Anesthesia and Intensive Care,“San Carlo”Hospital,Potenza 85100,Italy [5]Department of Anaesthesia,“San Giuliano”Hospital,Giugliano 80014,Italy [6]Unit of Anesthesia and Intensive Care,The Fondazione Policlinico Universitario Campus Bio-Medico,Rome 00128,Italy

出　　处：《World Journal of Orthopedics》2024年第9期882-890,共9页世界骨科杂志（英文版）

摘　　要：BACKGROUND The use of opioids for pain is linked to an increased risk of developing opioid use disorder,and has resulted in the emergence of the opioid crisis over the last few years.AIM The systematic review question is“How does the use of opioid medications in pain management,compared with non-opioid medications,affect pain intensity over the short,intermediate,and long-term in adults with acute traumatic pain?”.METHODS The protocol was prospectively registered on the International Prospective Re-gister of Systematic Reviews:CRD42021279639.Medline and Google Scholar were electronically searched for controlled peer-reviewed studies published in full,with the PICO framework:P:Adult patients with traumatic injuries,I:Opioid medications,C:Non-opioid medi-cations,O:A minimum clinically important difference(MCID)in pain.RESULTS After full-text screening,we included 14 studies in the qualitative synthesis.Of these 14 studies,12 were rando-mized clinical trials(RCTs)and 2 were pseudo-RCTs with a total of 2347 patients enrolled.There was heteroge-neity in both medication utilized and outcome in these studies;only two studies were homogeneous regarding the type of study conducted,the opioid used,its comparator,and the outcome explored.The MCID was evaluated in 8 studies,while in 6 studies,any measured pain reduction was considered as an outcome.In 11 cases,the setting of care was the Emergency Department;in 2 cases,care occurred out-of-hospital;and in one case,the setting was not well-specified.The included studies were found to have a low-moderate risk of bias.CONCLUSION Non-opioids can be considered an alternative to opioids for short-term pain management of acute musculoskeletal injury.Intravenous ketamine may cause more adverse events than other routes of administration.

关 键 词：Acute musculoskeletal injury Acute traumatic pain Non-opioid analgesia Non-opioid pain control Opioid-sparing analgesia Opioid crisis Opioid disorder Systematic review 

分 类 号：R651.2[医药卫生—外科学]