局麻药联合右美托咪定腹腔注射对腹腔镜手术后镇痛效果影响的系统评价

Intraperitoneal local anesthetic with Dexmedetomidine for postoperative analgesia after laparoscopic surgery: a systematic review

目的评价局麻药单用或联合右美托咪定(DEX)腹腔注射对腹腔镜手术后镇痛效果的影响。方法计算机检索Cochrane Library、PubMed、EMBase、中国生物医学文献数据库、万方数据库、中文数据库知网和维普数据库,收集比较局麻药单用(L组)或联合DEX腹腔注射(LD组)对腹腔镜手术后首次使用补救镇痛药的时间及补救镇痛药总用量等镇痛效果影响的临床随机对照试验。检索时间从建库至2019年8月。提取资料并评价纳入研究的偏倚风险后,采用Revman 5.3软件进行统计分析。结果最终纳入7项研究,共422例患者。分析结果显示,与L组比较,LD组术后首次使用补救镇痛药时间延长[MD=58.78,95%CI:(23.72,93.83),P=0.001],24 h补救镇痛药总用量减少[双氯芬酸:MD=-86.27,95%CI:(-127.95,-44.58),P <0.0001],术后肩痛的发生率降低[OR=0.16,95%CI:(0.08,0.31),P <0.000 01];两组恶心[OR=0.71,95%CI:(0.34,1.47),P=0.36]、呕吐[OR=0.40,95%CI:(0.16,1.01),P=0.05]等不良反应的发生率比较,差异无统计学意义。结论局麻药联合DEX腹腔注射能够提高腹腔镜手术后镇痛效果且不增加不良反应的发生。

Objective To assess the efficacy and safety of intraperitoneal local anesthetic with Dexmedetomidine(DEX for postoperative analgesia after laparoscopic surgery. Methods The PubMed, EMbase, Cochrane Library, CBM, Wanfang Database, China National Knowledge Infrastructure and VIP for all randomized controlled trials about intraperitoneal local anesthetic alone(group L) or with DEX(group LD) in laparoscopic surgery were searched. The retrieval period was from the establishment of the database to August 2019. Information was extracted and the research of risk of bias was evaluated, data was analyzed by RevMan5.3 software. Results Seven RCTs involving 422 patients were included. The results showed that compared with group L, group LD first use remedy postoperative analgesia drug prolonged [MD = 58.78, 95%CI:(23.72, 93.83), P = 0.001], 24 h remedial reduction total [Diclofenac: MD =-86.27, 95%CI:(-127.95,-44.58), P < 0.0001], the incidence of postoperative shoulder pain reduce [OR = 0.16, 95%CI:(0.08, 0.31),P < 0.000 01]. There was no significant difference in the incidence of adverse reactions such as nausea [OR = 0.71,95%CI:(0.34, 1.47), P = 0.36], vomiting [OR = 0.40, 95%CI:(0.16,1.01), P = 0.05] between the two groups. Conclusion Intraperitoneal local anesthetic combines with DEX can improve the analgesia effect after laparoscopic surgery without increasing the occurrence of adverse reaction.