关节镜治疗后镇痛:布比卡因关节腔内注射随机安慰剂对照的Meta分析

Analgesia after arthroscopic surgery: Randomly controlled Meta-analysis on intra-articular injection of bupivacaine placebo

背景:关节镜治疗后疼痛不但影响患者的生活质量,而且不利于患者治疗后的早期合理锻炼以及功能恢复。截止至2012年,国内外共发表了18篇关于关节镜治疗后关节腔内注射布比卡因用于术后镇痛的随机安慰剂对照试验,结果却不尽相同。目的:通过随机安慰剂对照试验的Meta分析,检验关节镜治疗后关节腔内注射布比卡因镇痛的有效性和安全性。方法:通过MEDLINE,Cochranelibrary,谷歌学术数据库检索截止至2012年4月有关使用布比卡因关节腔内注射用于关节镜治疗后镇痛的随机对照试验。检索关键词包括"布比卡因,关节腔内,关节镜,术后疼痛,安慰剂"。结果与结论:Meta分析共纳入18篇文献(n=934)(布比卡因组461例,安慰剂对照组473例)。结果显示,布比卡因组的目测类比评分数值较安慰剂对照组低(WMD:-1.39,95%CI:-2.17至-0.61,P<0.00001),且需要追加镇痛药的患者数少(RR:0.84,95%CI:0.62-1.66,P=0.010)。布比卡因组与安慰剂对照组相比,首次需要追加镇痛药离术后关节腔内注射的时间更长(WMD:157.72,95%CI:16.43-299.01,P<0.00001),并且2组不良反应发生率差异无显著性意义(RR:0.64,95%CI:0.29-1.44,P=0.48)。通过检索目前的相关文献发现,与安慰剂对照组相比,关节镜治疗后关节腔内注射布比卡因可以显著缓解疼痛且不增加并发症的发生率。

BACKGROUND： Pain after arthroscopic treatment can not only affect the patient＇s life quality, and is not conducive to the early reasonable exercise and functional recovery of the patients after treatment. Up to 2012, there are 18 randomized placebo-controlled trials on intra-articular injection of bupivacaine for analgesia after arthroscopic surgery, but the results are different. OBJECTIVE： To examine the efficacy and safety of intra-articular injection of bupivacaine in the management of pain after arthroscopic surgery through randomized placebo-controlled trials. METHODS： The MEDLINE database, Cochrane Central Register and Google Scholar database were retrieved for the randomized controlled trials on intra-articular injection of bupivacaine in the management of pain after arthroscopic surgery up to April 2012. The key words were ＂bupivacaine, intra-articular, arthroscopic,postoperative pain, placebo＂. RESULTS AND CONCLUSION： Eighteen studies （n=934） were included （461 cases in bupivacaine group 8nd 473 cases in the placebo control group）. The Meta-analysis results showed the visual analog scale score of the bupivacaine group was lower than that of the placebo control group （weighted mean difference： -1.39, 95% confidence idterval： -2.17 to -0.61, P 〈 0.000 01 ）, and the number of patients required supplementary analgesia was less than the placebo control group （relative risk： 0.84, 95% confidence interval： 0.62 to 1.66, P=0.010）. The time from first supplementary analgesia to postoperative intra-articular injection in the bupivacaine group was longer that in the placebo control group （weighted mean difference： 157.72, 95% confidence interval： 16.43 to 299.01, P 〈 0.000 01 ）. There was no significnt difference in the incidence of side effect between two groups （relative risk： 0.64, 95% confidence interval： 0.29 to 1.44, P=0.48）. On the basis of the currently available literature, the intra-articular of bupivacaine after arthroscopic surgery cab significantly relieve pain without increasing the adverse reactions when compared with the placebo control group.