普瑞巴林用于胸外科围手术期疼痛的快速卫生技术评估

Pregabalin in the perioperative pain management of thoracic surgery:a rapid health technology assessment

目的评价普瑞巴林用于胸外科围手术期疼痛的有效性、安全性和经济性,为临床药物选择和决策提供循证依据。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方数据库、中国生物医学文献服务系统和国内外卫生技术评估网站,收集普瑞巴林用于胸外科围手术期疼痛的中英文文献,检索时间均为数据库建库至2021年12月31日。由2名研究者独立根据纳入排除标准进行文献筛选、数据提取和质量评价,对研究结果进行综合性定性分析与比较。结果初筛获得28篇研究,最终纳入4篇研究,包括3篇系统评价或meta分析和1篇经济学研究,不同研究结果存在一定差异,开胸手术证据较多。研究结果显示,有效性和安全性方面,术前使用普瑞巴林(大部分为150 mg)有利于减少术后急性疼痛和阿片类药物消耗,镇静、头晕等不良反应差异无统计学意义;术后普瑞巴林多剂量使用(75或150 mg,每日2次)可减少急慢性疼痛、阿片类药物消耗和神经病理性疼痛,头晕、嗜睡发生率增加。经济学方面,普瑞巴林75 mg(每日2次)术后使用5 d,相比于硬膜外镇痛可节省手术服务和麻醉相关费用。结论基于当前有限的证据,普瑞巴林用于胸外科围手术期疼痛具有良好的有效性和经济性,多剂量使用时需关注其安全性,胸腔镜手术证据有限,该结论仍需进一步研究和临床实践予以证实。

Objective To rapidly evaluate the efficacy,safety and economy of pregabalin in perioperative pain management of thoracic surgery,and provide evidence-based basis for the selection of clinical treatment plan.Methods PubMed,Embase,Cochrane Library,Web of Science,CNKI,Wanfang,SinoMed and domestic and international health technology assessment websites were searched,and the retrieval time limit was from the establishment of the database to December 31,2021.Two researchers independently conducted literature screening,data extraction and quality evaluation according to the inclusion and exclusion criteria,and comprehensively and qualitatively analyzed and compared the study results.Results A total of 28 articles were initially selected,and 4 studies were included eventually,including 3 systematic reviews/meta-analyses and 1 economics study.There were some differences in the results between different studies,and the literature mainly focused on thoracotomy.In terms of efficacy and safety,preoperative pregabalin(mostly 150 mg)was beneficial to reduce acute pain and opioid consumption,and there was no significant difference in adverse reactions such as sedation and dizziness;postoperative multiple doses(75 mg bid or 150 mg bid)reduced acute and chronic pain,opioid consumption,and neuropathic pain,but increased the incidence of dizziness and somnolence.In terms of economics,pregabalin 75 mg bid for 5 days after surgery could save surgical services and anesthesia-related costs compared with epidural analgesia.Conclusion Based on the current limited evidence,pregabalin has good efficacy and economies in the perioperative pain management of thoracic surgery,and it is necessary to pay attention to its safety when using multiple doses.The evidence of thoracoscopic surgery is limited and the conclusion still needs to be confirmed by further studies and clinical practice.