帕瑞昔布钠超前镇痛用于全膝/髋关节置换术后疼痛的有效性及安全性的Meta分析

Meta-analysis of the effectiveness and safety of parecoxib sodium preemptive analgesia for pain after total knee/hip arthroplasty

目的系统评价帕瑞昔布钠超前镇痛用于全膝/髋关节置换术后的有效性和安全性。方法计算机检索PubMed、Embase、Cochrane Library、Medline、Web of Science、中国知网、维普、万方数据库从建库至2022年5月的帕瑞昔布钠超前镇痛用于全膝/髋关节置换术患者的随机对照试验相关文献。筛选文献、提取资料并使用改良的Jadad量表评价纳入文献的方法学质量,采用Rev Man 5.2软件进行Meta分析。结果共纳入27项随机对照试验,1816例患者。Meta分析结果显示,帕瑞昔布钠超前镇痛可有效降低术后疼痛视觉模拟评分[术后24h:均数差(mean difference,MD)=-0.70,95%置信区间(confidence interval,CI):-0.92~-0.47,P<0.001;术后48h:MD=-0.55,95%CI:-0.84~-0.27,P<0.001]、减少术后PCA药物消耗量(术后24h:MD=-24.30,95%CI:-34.69~-13.92,P<0.001;术后48h:MD=-11.94,95%CI:-17.61~-6.27,P<0.001),降低术后恶心、呕吐不良反应的发生率[相对危险度(relative risk,RR)=0.74,95%CI:0.58~0.94,P=0.020]。结论帕瑞昔布钠超前镇痛用于全膝/髋关节置换术后疼痛具有较好的疗效和较低的不良反应发生率。

Objective To systematically evaluate the efficacy and safety of parecoxib sodium preemptive analgesia for total knee/hip arthroplasty.Methods Retrieved from PubMed,Embase,Cochrane Library,Medline,Web of Science,CNKI,VIP and Wanfang databases during the inception to May 2022,randomized controlled trials about parecoxib sodium for preemptive analgesia of total knee/hip arthroplasty were collected.The methodological quality of the included literature was evaluated using a modified Jadad scale after screening the literature and extracting the data,and Meta-analysis was performed using RevMan 5.2 software.Results A total of 27 RCTs with 1816 patients were included.Meta-analysis showed that parecoxib sodium preemptive analgesia effectively decreased postoperative visual analogue scores[24 hours after operation:mean difference(MD)=-0.70,95%CI:-0.92 to-0.47,P<0.001;48 hours after operation:MD=-0.55,95%CI:-0.84 to-0.27,P<0.001],decreased postoperative patient controlled analgesia drug consumption(24 hours after operation:MD=-24.30,95%CI:-34.69 to-13.92,P<0.001;48 hours after operation:MD=-11.94,95%CI:-17.61 to-6.27,P<0.001),and decreased the incidence of postoperative nausea and vomiting[relative risk(RR)=0.74,95%CI:0.58 to 0.94,P=0.020].Conclusion Parecoxib sodium preemptive analgesia for total knee/hip arthroplasty has better analgesic efficacy and lower incidence of adverse reactions.