关节内注射可乐定对比吗啡对膝关节镜后镇痛作用的Meta分析

Intraarticular clonidine versus morphine for analgesia after arthroscopic knee surgery:A Meta-analysis

背景:关节内注射可乐定或吗啡均能产生镇痛作用,但二者的有效性和安全性存在争议。目的:系统评价关节内注射可乐定对比吗啡治疗膝关节镜术后疼痛的有效性和安全性。方法:计算机检索PubMed、EMBASE、CochraneLibrary、ISIWebofknowledge、中国生物医学文献数据库(CBM)、中文科技期刊全文数据库(VIP)、中国期刊全文数据库(CNKI)及万方数据库中关节内注射可乐定对比吗啡治疗膝关节镜术后疼痛的随机对照试验(RCT),检索时间均从建库至2012年1月。两位研究者按照纳入标准筛选文献、提取资料,按照改良Jadad评分表评价纳入研究质量,采用RevMan5.1进行Meta分析。结果与结论:纳入4个RCT,合计156例患者。Meta分析结果:①疼痛目测类比评分:二者在术后1,2,4,6,12,24h无差异。②有效镇痛时间:可乐定与吗啡相比能延长术后有效镇痛时间[MD=200.34,95%CI(177.67,223.00),P<0.01]。③术后镇痛药的需求率:二者差异无显著性意义[RR=1.05,95%CI(0.67,1.65),P=0.83]。④不良反应:二者在术后恶心、呕吐、过度镇静、皮肤瘙痒、低血压和心动过速等不良反应的发生方面的作用无差别。现有证据表明,关节内注射可乐定与吗啡对膝关节镜术后疼痛的缓解程度相同,术后镇痛药的需求率也无明显差异,但可乐定能产生更长的镇痛作用,二者不良反应发生率无差异,结果尚需开展更多研究来证实。

BACKGROUND： Both intraarticular clonidine and morphine can provide analgesic effect, but the efficacy and safety of them are uncertain. OBJECTIVE： To evaluate the efficacy and safety of intraarticular clonidine versus morphine for postoperative analgesia following arthroscopic knee surgery. METHODS： PubMed database, EMBASE database, Cochrane Library, ISI Web of knowledge, CBM database, VIP database, CNKI database and Wanfang database were searched from their start year up to January 2012 for relevant randomized clinical trials on the intraarticular clonidine versus morphine for postoperative analgesia following arthroscopic knee surgery. Randomized clinical trials met the inclusion criteda were screened and included, and the quality was evaluated using seven-point Jadad scale and the data was analyzed using RevMan 5. 1.RESULTS AND CONCLUSION： Four randomized clinical trials including 156 patients were included. The results of the Meta analysis showed： ①Visual analogue scale scores： there was no difference between intraarticular clonidine and morphine on the visual analogue scale scores at 1, 2, 4, 6, 12 and 24 hours after intraarticular; ② Effective analgesia： intraarticular clonidine could provide longer effective analgesia than morphine [mean difference （MD）=200.34, 95% confidence interval （C/）（177.67, 223.00）, P 〈 0.01]; ③Rate of postoperative analgesic requirements： there was no significant difference of the rate of postoperative analgesic requirements between the two drugs relative risk （RR）=1.05, 95%C/（0.67, 1.65）, P=0.83]; ④The incidence of side effects had no significant differences. The current evidence shows that there is no difference between intraarticular rejection of clonidine and morphine on the pain intensity and the rate of postoperative analgesic requirements, but intraarticuiar clonidine provides longer effective analgesia, and the incidence of side effects is similar. Yet more randomized clinical trials with large sample size are required to explore the question clearly.