Abstract：
While serotonin norepinephrine reuptake inhibitors (SNRIs) offer promise in managing Post-surgical neuropathic pain (PSNP), uncertainties remain. This study aims to evaluate the effectiveness and adverse events of SNRIs in managing PSNP.
Systematic searches of PubMed, Embase, and Cochrane databases up to January 1st 2023 identified randomized controlled trials (RCTs) comparing SNRIs to placebo for PSNP. The primary outcome measures were pain at rest and adverse events post-surgery. Subgroup analyses were conducted based on surgical type and specific SNRIs.
A total of 19 RCTs, encompassing 1440 participants (719 in the SNRI group vs 721 in the placebo group), met the inclusion criteria and were included. The pooled results demonstrated that pain scores were significantly lower in patients treated with SNRIs at 2 hours (MD:-0.26; 95%CI: -0.47 to -0.04; p=0.02), 6 hours (MD:-0.68; 95%CI: -1.01 to -0.34; p<0.0001), 24 hours (MD:-0.54; 95%CI: -0.99 to -0.09; p=0.02), and 48 hours (MD:-0.66; 95%CI: -1.23 to -0.10; p=0.02) post-surgery. In terms of adverse events, dizziness (OR:2.53; 95%CI: 1.34-4.78; p=0.004) and dry mouth (OR:2.21; 95%CI: 1.25-3.92; p=0.007) were significantly higher in the SNRIs group. Subgroup analysis showed that SNRI was found to significantly lower the 24-hour pain score after spinal surgery (MD:-0.45; 95%CI: -0.84 to -0.05; p=0.03). Duloxetine (MD:-0.63; 95%CI: -1.15 to -0.11; p=0.02) had a significant effect in lowering the 24-hour pain score at rest compared to placebo, whereas venlafaxine did not.
SNRIs yielded considerable pain score reductions across multiple post-surgical intervals, although accompanied by an increased incidence of dizziness and dry mouth.
Systematic searches of PubMed, Embase, and Cochrane databases up to January 1st 2023 identified randomized controlled trials (RCTs) comparing SNRIs to placebo for PSNP. The primary outcome measures were pain at rest and adverse events post-surgery. Subgroup analyses were conducted based on surgical type and specific SNRIs.
A total of 19 RCTs, encompassing 1440 participants (719 in the SNRI group vs 721 in the placebo group), met the inclusion criteria and were included. The pooled results demonstrated that pain scores were significantly lower in patients treated with SNRIs at 2 hours (MD:-0.26; 95%CI: -0.47 to -0.04; p=0.02), 6 hours (MD:-0.68; 95%CI: -1.01 to -0.34; p<0.0001), 24 hours (MD:-0.54; 95%CI: -0.99 to -0.09; p=0.02), and 48 hours (MD:-0.66; 95%CI: -1.23 to -0.10; p=0.02) post-surgery. In terms of adverse events, dizziness (OR:2.53; 95%CI: 1.34-4.78; p=0.004) and dry mouth (OR:2.21; 95%CI: 1.25-3.92; p=0.007) were significantly higher in the SNRIs group. Subgroup analysis showed that SNRI was found to significantly lower the 24-hour pain score after spinal surgery (MD:-0.45; 95%CI: -0.84 to -0.05; p=0.03). Duloxetine (MD:-0.63; 95%CI: -1.15 to -0.11; p=0.02) had a significant effect in lowering the 24-hour pain score at rest compared to placebo, whereas venlafaxine did not.
SNRIs yielded considerable pain score reductions across multiple post-surgical intervals, although accompanied by an increased incidence of dizziness and dry mouth.
摘要：
背景：虽然5-羟色胺去甲肾上腺素再摄取抑制剂（SNRIs）有望治疗术后神经性疼痛（PSNP），不确定性依然存在。本研究旨在评估SNRIs在PSNP管理中的有效性和不良事件。
方法：PubMed的系统搜索，Embase,截至2023年1月1日，Cochrane数据库确定了将SNRIs与安慰剂进行PSNP比较的随机对照试验(RCT)。主要结果指标为休息时疼痛和术后不良事件。根据手术类型和具体SNRI进行亚组分析。
结果：总共19项RCT，涵盖1440名参与者（SNRI组719名，安慰剂组721名），符合纳入标准并被纳入。汇总结果表明，使用SNRIs治疗的患者在2小时时疼痛评分显着降低（MD：-0.26;95CI：-0.47至-0.04;p=0.02），6小时（MD：-0.68；95CI：-1.01至-0.34；p<0.0001），24小时（MD：-0.54；95CI：-0.99至-0.09；p=0.02），术后48小时（MD：-0.66；95CI：-1.23至-0.10；p=0.02）。在不良事件方面，SNRIs组头晕(OR:2.53;95CI:1.34-4.78;p=0.004)和口干(OR:2.21;95CI:1.25-3.92;p=0.007)显著高于SNRIs组。亚组分析显示，发现SNRI显着降低脊柱手术后24小时疼痛评分（MD：-0.45；95CI：-0.84至-0.05；p=0.03）。与安慰剂相比，度洛西汀（MD：-0.63;95CI：-1.15至-0.11;p=0.02）在降低休息时24小时疼痛评分方面具有显着效果，而文拉法辛没有。
结论：SNRIs在多个术后间隔内产生了相当大的疼痛评分降低，尽管伴有头晕和口干的发生率增加。
方法：PubMed的系统搜索，Embase,截至2023年1月1日，Cochrane数据库确定了将SNRIs与安慰剂进行PSNP比较的随机对照试验(RCT)。主要结果指标为休息时疼痛和术后不良事件。根据手术类型和具体SNRI进行亚组分析。
结果：总共19项RCT，涵盖1440名参与者（SNRI组719名，安慰剂组721名），符合纳入标准并被纳入。汇总结果表明，使用SNRIs治疗的患者在2小时时疼痛评分显着降低（MD：-0.26;95CI：-0.47至-0.04;p=0.02），6小时（MD：-0.68；95CI：-1.01至-0.34；p<0.0001），24小时（MD：-0.54；95CI：-0.99至-0.09；p=0.02），术后48小时（MD：-0.66；95CI：-1.23至-0.10；p=0.02）。在不良事件方面，SNRIs组头晕(OR:2.53;95CI:1.34-4.78;p=0.004)和口干(OR:2.21;95CI:1.25-3.92;p=0.007)显著高于SNRIs组。亚组分析显示，发现SNRI显着降低脊柱手术后24小时疼痛评分（MD：-0.45；95CI：-0.84至-0.05；p=0.03）。与安慰剂相比，度洛西汀（MD：-0.63;95CI：-1.15至-0.11;p=0.02）在降低休息时24小时疼痛评分方面具有显着效果，而文拉法辛没有。
结论：SNRIs在多个术后间隔内产生了相当大的疼痛评分降低，尽管伴有头晕和口干的发生率增加。
