Introduction:Postoperative pain management is complex and crucial in major gynecology oncological surgery. Currently, there is no well-defined standardized approach, resulting in significant variability in practices worldwide. This systematic review evaluates the effectiveness of analgesic strategies used postoperatively in gynecological cancer surgery.Methods:A systematic review was conducted from inception to June 26th 2024 to identify all randomized controlled trials (RCTs) assessing pain management following any surgery for gynecological cancer. This was performed on the CENTRAL, PubMed, Embase, and MEDLINE databases.Results:A total of 46 RCTs met the inclusion criteria. Of these 5316 patients, 1844 patients had cervical cancer, 99 had endometrial cancer, and 158 had ovarian cancer. The remaining 3215 participants had unspecified gynecological cancers or benign pathology. No studies focused on postoperative analgesia for vulval cancer. A meta-analysis was not feasible due to heterogeneity in study design, analgesic interventions (i.e., opioids, local anesthetics, paracetamol, NSAIDs, and holistic and complementary therapies), and multiple routes of administration (i.e., oral, parenteral, regional, neuraxial, local infiltration, intraperitoneal, intramuscular, patient-controlled, topical, and rectal). No single analgesic modality demonstrated clear superiority. The median Jadad score for methodological quality of the included trials was 4.Conclusions:The limited cancer-specific RCTs and diversity of analgesia modalities utilized reflect the wide range of applications. Postoperative pain is multifactorial and cannot be adequately managed with a single agent. National and international guidelines should aim to establish a standardized framework for postoperative pain management in gynecological cancers, ensuring accessible, evidence-based care that enhances both short- and long-term patient quality of life.
引言：在妇科肿瘤大手术中，术后疼痛管理复杂且至关重要。目前尚无明确的标准方法，导致全球实践存在显著差异。本系统综述评估了妇科癌症手术后镇痛策略的有效性。 方法：通过系统检索CENTRAL、PubMed、Embase和MEDLINE数据库，收集自建库至2024年6月26日期间评估妇科癌症手术后疼痛管理的所有随机对照试验。 结果：共纳入46项随机对照试验，涉及5316例患者。其中宫颈癌1844例，子宫内膜癌99例，卵巢癌158例，其余3215例为未明确分类的妇科癌症或良性病变。未发现专门针对外阴癌术后镇痛的研究。由于研究设计、镇痛干预措施（包括阿片类药物、局部麻醉药、对乙酰氨基酚、非甾体抗炎药及整体与补充疗法）及给药途径（口服、肠外、区域阻滞、椎管内、局部浸润、腹腔内、肌肉注射、患者自控、经皮及直肠给药）的异质性，无法进行荟萃分析。未发现单一镇痛模式具有明确优势。纳入试验方法学质量的Jadad评分中位数为4分。 结论：现有癌症特异性随机对照试验有限且镇痛方式多样，反映了临床应用的广泛性。术后疼痛具有多因素性，单一药物无法充分控制。国内外指南应致力于建立妇科癌症术后疼痛管理的标准化框架，确保提供可及且基于证据的医疗照护，以提升患者短期及长期生活质量。
Postoperative Pain Following Gynecology Oncological Surgery: A Systematic Review by Tumor Site
肿瘤(癌症)患者之家