普瑞巴林用于腹腔镜手术后急性疼痛的有效性和安全性系统综述和Meta分析

Efficacy and safety of pregabalin for acute postoperative pain after laparoscopic surgery: a systematic review and Meta-analysis

目的:评价普瑞巴林用于腹腔镜手术后的镇痛效果和不良反应。方法:计算机检索建库至2019年10月,在Pubmed,Embase,Cochrane library,中国知网、万方数据库和维普中文科技期刊数据库发表的普瑞巴林用于腹腔镜手术后镇痛的随机对照研究。从符合纳入标准的文献中提取数据,采用Revman 5.3软件进行分析。结果:共纳入18项研究1 169例患者,镇痛效果方面:普瑞巴林组术后24 h患者疼痛视觉模拟评分(VAS)显著低于对照组(MD=-8.34 mm,95%CI:-11.68~-4.99,P <0.001),术后24 h吗啡用量低于对照组(MD=-5.88 mg,95%CI:-7.66~-4.11,P <0.001)。不良反应方面:普瑞巴林组术后24 h恶心呕吐发生率明显低于对照组(RR=0.75,95%CI:0.62~0.92,P=0.006),术后视物模糊发生率明显高于对照组(RR=2.86,95%CI:1.33~6.18,P=0.007)。两组术后头晕和镇静发生率差异无统计学意义(RR=1.08,95%CI:0.82~1.42,P=0.59;RR=2.41,95%CI:0.44~13.17,P=0.31)。结论:普瑞巴林用于不同种类腹腔镜手术后镇痛时,可降低术后疼痛评分,节省阿片用量,并减少术后恶心呕吐发生。推荐术前单次用药模式,以减少视物模糊发生。

Objective: To evaluate the analgesic and adverse effects of pregabalin after laparoscopic surgery.Methods: Pubmed,Embase,Cochrane library,China Knowledge Network,Wanfang database and VIP database were searched for randomized controlled trials( RCT) that investigated pregabalin analgesa in adult patients undergoing laparoscopic surgery from inception to October 2019. RevMan 5. 3 was used to perform analysis. Results: Eighteen RCTs with a total of 1169 subjects were included. Pregabalin was associated with a significant reduction in pain scores and opioid consumption at 24 h compared with placebo( MD =-8. 34 mm,95% CI:-11. 68 ~-4. 99,P < 0. 001 and MD =-5. 88 mg,95% CI:-7. 66 ~-4. 11,P < 0. 001). Patients receiving pregabalin had less postoperative nausea and vomiting compared with placebo( RR = 0. 75,95% CI: 0. 62 ~ 0. 92,P = 0. 006). Visual disturbance was more common in pregabalin group compared with placebo group( RR = 2. 86,95% CI: 1. 33 ~ 6. 18,P = 0. 007). There was no significant difference in the incidence of dizziness and sedation between the two groups( RR = 1. 08,95% CI: 0. 82 ~ 1. 42,P = 0. 59;RR = 2. 41,95% CI: 0. 44 ~ 13. 17,P = 0. 31). Conclusions:Perioperative administration of pregabalin may decrease pain scores,opioid consumption,nausea and vomiting when used in different types of laparoscopic surgery. Single preoperative dose is recommended to reduce the occurrence of visual disturbance.