Purpose

The opioid epidemic has prompted an emphasis on investigating opioid-sparing alternatives for pain management following knee arthroscopy. This review evaluated the effects of perioperative nonopioid adjunct analgesia on postoperative opioid consumption and pain control in patients undergoing knee arthroscopy.

Methods

A systematic review and meta-analysis was performed using the following databases: PubMed, Embase, Web of Science, MEDLINE, and SCOPUS. Prospective comparative studies assessing the efficacy of various perioperative nonopioid analgesic strategies in patients undergoing knee arthroscopy were included. Twenty-five studies (n = 2408) were included.

Results

Pre-emptive nonopioid pain medications demonstrated a reduction in cumulative postoperative oral morphine equivalent (OME) consumption by 11.8 mg (95% CI − 18.3, − 5.4, p ≤ 0.0001) and VAS pain scores by 1.5 (95% CI − 2.3, − 0.7, p < 0.001) at 24 h compared to placebo. Postoperative nonopioid pain medications significantly reduced cumulative postoperative OME consumption by 9.7 mg (95% CI − 14.4, − 5.1, p < 0.001) and VAS pain scores by 1.0 (95% CI − 1.354, − 0.633, p < 0.001) at 24 h compared to placebo. Saphenous nerve blocks significantly reduced cumulative postoperative OME consumption by 6.5 mg (95% CI − 10.3, − 2.6, p = 0.01) and VAS pain scores by 0.8 (− 1.4, − 0.3, p = 0.03) at 24 h compared to placebo. Both preoperative patient education and postoperative cryotherapy reduced postoperative opioid consumption.

Conclusion

Perioperative nonopioid pharmacotherapy, saphenous nerve blocks, and cryotherapy for patients undergoing knee arthroscopy significantly reduce opioid consumption and pain scores when compared to placebo at 24 h postoperatively. These interventions should be considered in efforts to reduce opioid consumption in patients undergoing knee arthroscopy. More research is needed to determine which interventions can reduce pain outside of the immediate postoperative period and the potential synergistic effects of combining interventions.

Level of evidence

II.

中文翻译：

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围手术期非阿片类药物镇痛可减少膝关节镜检查术后的阿片类药物消耗：系统评价和荟萃分析。

目的

阿片类药物的流行促使人们着重研究膝关节镜检查后为镇痛而研究的阿片类药物替代疗法。这项评价评估了围手术期非阿片类药物辅助镇痛对膝关节镜检查患者术后阿片类药物消耗和疼痛控制的影响。

方法

使用以下数据库进行了系统的综述和荟萃分析：PubMed，Embase，Web of Science，MEDLINE和SCOPUS。包括前瞻性比较研究，评估各种围手术期非阿片类镇痛策略对膝关节镜检查患者的疗效。 纳入了25项研究（n = 2408）。

结果

先发制人非阿片类止痛药由11.8毫克（ - - 18.3，5.4，95％CI证明在累积术后口服吗啡当量（OME）消耗的减少p 和VAS疼痛评分1.5（95％CI - 2.3，≤0.0001） - 与安慰剂相比，在24小时时为0.7，p <0.001）。术后非阿片类药物 在24 h时可显着减少术后OME累积摄入量9.7 mg（95％CI-14.4，-5.1，p  <0.001）和VAS疼痛评分1.0（95％CI-1.354，-0.633，p <0.001）与安慰剂相比。隐神经阻滞可显着减少术后OME累计摄入量6.5 mg（95％CI-10.3，-2.6，p  = 0.01）和VAS疼痛评分降低0.8（-1.4，-0.3，p = 0.03）在24小时时与安慰剂相比。术前患者教育和术后冷冻治疗均减少了术后阿片类药物的消耗。

结论

与术后24小时的安慰剂相比，对于接受膝关节镜检查的患者，围手术期非阿片类药物治疗，隐神经阻滞和冷冻治疗显着降低了阿片类药物的消耗和疼痛评分。在减少膝关节镜检查患者的阿片类药物消耗量时应考虑这些干预措施。需要更多的研究来确定哪些干预措施可以减轻术后即刻疼痛，以及联合采取干预措施的潜在协同作用。

证据水平

二。