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

World Journal of Orthopedics 2024年第9期15卷 882-890页

作者： Marco Fiore Luigi Aurelio Nasto Eleni McCaffery Fannia Barletta Angela Visconti Francesca Gargano Enrico Pola Maria Caterina Pace Department of Women Child and General and Specialized SurgeryUniversity of Campania“Luigi Vanvitelli”Naples 80138Italy Department of Orthopaedics University of Campania“Luigi Vanvitelli”Naples 80138Italy Department of Emergency Medicine New York Presbyterian-Brooklyn Methodist HospitalNew YorkNY 11215United States Department of Anesthesia and Intensive Care “San Carlo”HospitalPotenza 85100Italy Department of Anaesthesia “San Giuliano”HospitalGiugliano 80014Italy Unit of Anesthesia and Intensive Care The Fondazione Policlinico Universitario Campus Bio-MedicoRome 00128Italy

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 *** 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:*** 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 *** After full-text screening,we included 14 studies in the qualitative *** these 14 studies,12 were rando-mized clinical trials(RCTs)and 2 were pseudo-RCTs with a total of 2347 patients *** 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 *** MCID was evaluated in 8 studies,while in 6 studies,any measured pain reduction was considered as an *** 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 *** included studies were found to have a low-moderate risk of *** Non-opioids can be considered an alternative to opioids for short-term pain management of acute musculoskeletal *** 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

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