The American journal of sports medicine · 2026 · 系統性回顧＋統合分析（依標題推測）

Preoperative Nonopioid Analgesia Reduces Postoperative Opioid Consumption After Arthroscopic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

全身性肌肉骨骼・風濕・疼痛 · 術後疼痛管理

中文閱讀摘要

系統性回顧與統合分析顯示，術前非鴉片類藥物顯著降低關節鏡術後鴉片類藥物用量，但臨床意義有限且異質性高。

AI 依來源摘要整理，未經人工逐篇核對。閱讀結論前，請回溯研究族群、方法與限制。

原始摘要

Background

Orthopaedic surgeons frequently overprescribe opioids after arthroscopic surgery. Previous research has shown reductions in postoperative opioid consumption and pain scores with multimodal nonopioid analgesics. However, the clinical effect of preoperative analgesic strategies has not been fully uncovered.

Purpose

To assess the outcomes of arthroscopic surgery associated with preoperative treatment with nonopioid medications.

Study design

Systematic review and meta-analysis; Level of evidence, 1.

Methods

Three online databases (PubMed, MEDLINE, Embase) were searched on December 12, 2024, to identify randomized controlled trials investigating the effect of preoperative intervention on pain management following arthroscopic surgery. Extracted data included patient demographics, surgery type, analgesic protocols (ie, type, dosing, timing), adverse effects, postoperative opioid consumption, and pain scores. Postoperative opioid consumption was standardized and converted to oral morphine equivalents. Pain scores were assessed using the visual analog scale (VAS). Weighted means and meta-analyses were conducted to compare postoperative outcomes. Subgroup analyses were performed by analgesic class (COX-2 inhibitors, gabapentin) and surgery type. The quality of studies was assessed with the Risk of Bias 2 tool.

Results

A total of 22 studies were included in this review. The overall pooled mean reduction in postoperative opioid consumption with any preoperative medication type was 4.3 mg of oral morphine equivalents (95% CI, -6.1 to -2.5; P < .001; I 2 = 96%) at 24 hours. The pooled mean reduction associated with preoperative COX-2 administration and gabapentin was 4.2 mg (95% CI, -7.9 to -0.5; P = .03; I 2 = 93%) and 6.3 mg (95% CI, -9.6 to -3.0; P < .001; I 2 = 90%) at 24 hours, respectively. Preoperative COX-2 inhibitors also yielded a statistically significant VAS pain reduction of 0.3 cm (95% CI, -0.5 to -0.02; P = .04). Patients undergoing anterior cruciate ligament reconstruction had higher postoperative opioid consumption as compared with general knee or shoulder arthroscopies.

Conclusion

This systematic review demonstrated that preoperative treatment with nonopioid medications, particularly COX-2 inhibitors and gabapentin, is associated with statistically significant reductions in postoperative opioid consumption after arthroscopic surgery. Despite statistically significant findings, observed reductions in postoperative opioid consumption and VAS pain scores may not represent clinically meaningful improvements. The current available literature is highly heterogeneous, indicating the need for high-quality prospective studies to more accurately assess optimal approaches to pain management.

至 Europe PMC 閱讀完整來源 ↗ · 擷取日期 2026-10-19

書目、來源與全文狀態

DOI: 10.1177/03635465251396164
PMID／PMCID: 41527448 / PMC13133421
作者: Dworsky-Fried J, Fowler R, Vivekanantha P, Cohen D, Simunovic N, de Sa D, Ayeni OR
首次發表日期: 2026-01-13Europe PMC 提供，部分日期可能依年份或月份推定。
卷／期／頁碼或文章編號: 54 ／ 6 ／ 1509-1524
書目來源與查核日期: Europe PMC · 2026-10-19僅核對書目欄位與來源連結；不代表已評讀研究品質。
全文與授權: 來源列有免費全文（查核 2026-10-19），未逐篇測試 PDF 下載。來源授權標示：cc by。

可回溯引用

Dworsky-Fried J, Fowler R, Vivekanantha P, Cohen D, Simunovic N, de Sa D, Ayeni OR. Preoperative Nonopioid Analgesia Reduces Postoperative Opioid Consumption After Arthroscopic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. The American journal of sports medicine. 2026;54(6):1509-1524. PMID: 41527448. PMCID: PMC13133421. doi:10.1177/03635465251396164

原始文獻 ↗來源列出的免費全文 ↗

本站供教育與研究參考。單篇摘要、文體標籤與期刊影響係數不等於證據品質或個別病人的診療建議。