脂质体布比卡因减少全膝关节置换术后疼痛有效性的meta分析

Efficacy of liposomal bupivacaine on pain after total knee arthroplasty:a meta-analysis

背景:全膝关节置换术(TKA)后患者疼痛十分常见,脂质体布比卡因对TKA后疼痛控制效果尚不明确。目的:通过meta分析评价脂质体布比卡因对减少TKA后疼痛的有效性。方法:计算机检索Cochrane Library、Embase、Pubmed等英文数据库及万方数据库、中国知网数据库,研究时间在1983～2017年所有关于应用脂质体布比卡因治疗TKA后疼痛的随机对照试验(RCTs),使用Cochrane风险评估工具对纳入的文献进行方法学质量评价,使用Stata12.0软件进行meta分析。结果:共纳入7篇文献825例患者(脂质体布比卡因组413例;对照组412例)。与对照组比较,脂质体布比卡因显著减少术后72 h疼痛(VAS)评分(WMD=-4.22,95%CI:-7.47～-0.97)。脂质体布比卡因与对照组在术后24 h VAS评分(WMD=0.92,95%CI:-2.05-3.88),48 h VAS评分(WMD=-2.53,95%CI:-6.39～2.19),总吗啡消耗量(WMD=-0.49,95%CI:-10.19～9.20),住院时间(WMD=0.15.95%CI:-0.02～0.31)及术后恶心发生率(RR=0.92,95%CI:0.76～1.12)方面差异均无统计学意义(P>0.05)。结论:脂质体布比卡因可延长TKA患者术后镇痛时间,但是并不能减少吗啡消耗量、住院时间及术后恶心发生率。由于样本量少及随访时间较短,需要大样本临床随机对照研究进一步确定脂质体布比卡因的疗效。

Background: Pain is very common after total knee arthroplasty, and the effect of liposomal bupivacaine on pain control after total knee arthroplasty is not clear. Objective: To evaluate the effectiveness of liposomal bupivacaine(LB) on postoperative pain in patients undergoing total knee arthroplasty(TKA). Methods: The electronic databases including Cochrane Library、Embase、Pubmed,WanFang and CNKI were searched for the randomized controlled trials(RCTs) that evaluating the effectiveness of LB on postoperative pain in patients receiving TKA between 1983 and 2017. A quality assessment of the included literatures was conducted using the Cochrane risk assessment tool. Stata 12.0 software was used for the analysis. Results:Seven RCTs enrolling 825 patients, with 413 in the LB group and 412 in the control group were involved in this meta-analysis.Compared with the control group, the LB group had significantly lower VAS at 72 h after TKA(WMD=-4.22, 95%CI:-7.47--0.97). There were no significant difference in VAS at 24 h(WMD=0.92, 95%CI:-2.05-3.88), 48 h(WMD=-2.53, 95%CI:-6.39-2.19), total morphine consumption(WMD=-0.49, 95%CI:-10.19-9.20), the length of hospital stay(WMD=0.15, 95%CI:-0.02-0.31), and the rate of postoperative nausea(RR=0.92, 95%CI: 0.76-1.12). Conclusions: Administration with LB is associated with a prolonged pain-relieving effect. However, it cannot shorten the length of hospital stay, total morphine consumption and the rate of postoperative nausea. Due to the limited sample size and short follow up period, the effectiveness of LB on pain after TKA requires large number and high quality RCTs to identify.