关节腔内注射右美托咪定联合罗哌卡因对膝关节镜术后镇痛的有效性及安全性的Meta分析

Safety and Analgesic Efficacy of Intra-articular Injection of Dexmedetomidine Combined with Ropivacaine in Arthroscopic Knee Surgery: A Meta-analysis

目的通过Meta分析研究关节腔内注射右美托咪定联合罗哌卡因对膝关节镜术后镇痛的有效性及安全性。方法检索CBM、VIP、Wan Fang Data、CNKI以及Pubmed等数据库,收集建库日期至2018年1月内所有关节腔内注射右美托咪定联合罗哌卡因对膝关节镜术后镇痛的随机对照试验。采用Rev Man5. 3软件进行Meta分析。结果纳入10项研究,共520例患者。Meta分析结果显示:术后1 h、2 h、4 h、6 h、8 h,右美托咪定联合罗哌卡因的VAS评分低于对照组,差异有统计学意义,而术后12 h、18 h、20 h、24 h,两组差异无统计学意义。右美托咪定联合罗哌卡因能够延长镇痛作用持续时间,减少术后24小时内芬太尼或地佐辛使用量,并且不会增加恶心和呕吐、低血压、心动过缓等不良反应发生的风险。结论关节腔内注射右美托咪定联合罗哌卡因可以增强膝关节镜术后的镇痛效果,延长术后镇痛作用持续时间,减少镇痛药物使用量,并且不会增加不良反应的发生。但由于目前纳入研究的方法学质量普遍较低,今后有必要开展高质量、大样本和多中心和试验进一步验证。

Objective To evaluate the efficacy and safety of intra-articular injection of dexmedetomidine plus ropivacaine for postoperative pain relief in patients undergoing knee arthroscopy. Methods The databases of CBM, VIP, WanFang Data, CNKI and Pubmed were searched, and all of the randomized controlled trials of intra-articular injection of dexmedetomidine combined with ropivacaine for postoperative pain relief after knee arthroscopy in the period between the date of construction and January 2018 was collected. Meta-analysis was performed by RevMan 5.3 software. Results Ten RCTs involving 520 participants were included in our systematic review. Meta analysis showed that compared with the control group, the VAS score of the experimental group at 1 h, 2 h, 4 h, 6 h, 8 h after operation was lower, and the difference was statistically significant, but there was no statistical difference between the two groups at 12 h, 18 h, 20 h and 24 h after operation signifi- cance. Dexmedetomidine combined with ropivacaine can prolong the duration of analgesic effect and reduce the amount of fentanyl or dezocine used within 24 hours after operation, and will not increase nausea and vomiting, hypotension, bradycardia and other adverse reactions risk of reaction. Conclusion Intra-articular injection of dexmedetomidine combined with ropivacaine can enhance the analgesic effect after knee arthroscopy, prolong the duration of postoperative analgesia, reduce the use of analgesic drugs, and will not increase adverse reactions happened. However, due to the generally low quality of methodologies currently under study, there is a need for further validation of high quality, large sample and multieenter studies and trials in the future.