Objective To assess the effectiveness and safety of local versus systemic application of opioids for labor analgesia. Methods We searched PubMed (1966 to January 2008), EMBASE (1980 to January 2008), The Cochrane Library (Issue 1, 2008), CBM (1978 to January 2008), CNKI (1979 to January 2008) for randomized controlled trials (RCTs) involving local versus systemic application of opioids for labor analgesia. Quality assessment and data extraction were conducted by two reviewers independently. Meta-analyses were conducted with The Cochrane Collaboration’s RevMan 4.2.10 software. Results A total of 12 trials involving 5909 participants met the inclusion criteria. Meta-analyses showed that local application of opioids was superior to systemic application in terms of maternal satisfaction with pain relief during labor (RR 1.63, 95% CI 1.27 to 2.09). No significant difference was found between the two groups in the incidence of low neonatal Apgar score at 5 minutes (RR 0.63, 95% CI 0.40 to 1.01). Conclusion Local application of opioids for labor analgesia appears to be more effective than systematic use in reducing pain during labor. But as for safety concerns, maternal and neonatal adverse effects are observed in both groups. Thus, more high-quality and large-scale RCTs are needed.
ObjectiveTo evaluate the relationship between OPRM1 gene rs1799971 polymorphism and opioid analgesics requirement after surgery in Asians. MethodsWe electronically searched databases including CNKI, CBM, VIP, WanFang Data, EMbase and MEDLINE to collect studies about the correlation between OPRM1 gene rs1799971 polymorphism and opioid analgesics requirement after surgery in Asia. The retrieval time was from the establishment to March 1st, 2015. Two reviewers independently screened literature, extracted data and assessed the risk bias of including studies, and then meta-analysis was performed by using RevMan 5.2 software. ResultsA total of 10 case-control studies involving 1 612 patients were included. The results of meta-analysis showed that the requirement of opioid analgesics after surgery for GG genotype carriers was more than AG carriers (SMD=-0.44, 95%CI -0.61 to -0.28, P<0.000 01), AA genotype carriers (SMD=-0.55, 95%CI -0.71 to -0.38, P<0.000 01), and AA+AG genotype carriers (SMD=-0.50, 95%CI -0.66 to -0.35, P<0.000 01). ConclusionThe current evidence showed that the requirement of opioid analgesics after surgery for GG genotype of rs1799971 polymorphism in OPRM1 gene is higher in Asians. Due to the limited quality and quantity of included studies, the above results are needed to be further validated by more studies.
In 2020, the American Association of Hip and Knee Surgeons (AAHKS), the American Society of Regional Anesthesia and Pain Medicine (ASRA), the American Academy of Orthopaedic Surgeons (AAOS), the American Hip Society (THS), the American Knee Society (TKS) have worked together to develop clinical practice guidelines on the use of Opioids in primary total joint arthroplasty (TJA). This clinical practice guideline formulates recommendations for common and important questions related to the efficacy and safety of Opioids in primary TJA. This article interprets the guideline to help doctors make clinical decisions.