目的:对随机对照试验(RCTs)进行系统评价和荟萃分析,评估围手术期静脉注射利多卡因与安慰剂在改善功能性内窥镜鼻窦手术(FESS)手术领域质量方面的疗效。
方法:PubMed,Scopus,WebofScience,从成立到2023年6月,对CENTRAL进行了彻底搜索。通过RoB-2工具评估所包括的RCT。我们的主要终点包括术中手术野质量,次要终点涉及手术持续时间,估计失血量,麻醉后监护病房(PACU)出院时间,术后疼痛,平均心率差异(HR),和平均动脉压(MAP)的平均差异。通过RevMan软件将连续数据汇集为平均差(MD)或标准化平均差(SMD)。此外,根据GRADE系统评估每个结局的证据确定性.
结果:共纳入4个RCT,共267例患者。关于手术领域的术中质量,结果表明,与安慰剂组相比,利多卡因组有显著差异(n=3个随机对照试验,MD-0.80,95%CI[-0.98,-0.61],p<0.001,证据的中等确定性)。试验序贯分析显示,有大量确凿的证据。关于PACU放电的时间,利多卡因组有显著性差异(p<0.05)。相反,利多卡因组和安慰剂组在手术持续时间方面没有显着差异,估计失血量,术后疼痛,MAP和HR的平均变化,(p>0.05)。
结论:我们的综述显示,利多卡因输注,与安慰剂相比,显着改善了手术视野,缩短了PACU排出所需的时间。然而,利多卡因并没有减少手术时间,估计失血量,术后疼痛,MAP,或HR。
OBJECTIVE: To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) that assessed the efficacy of perioperative intravenous lidocaine versus placebo in improving the quality of surgical field during functional endoscopic sinus surgery (FESS).
METHODS: PubMed, Scopus, Web of Science, and CENTRAL were thoroughly searched from inception until June 2023. The included RCTs were evaluated via RoB-2 tool. Our primary endpoint included intraoperative surgical field quality, and secondary endpoints involved operative duration, estimated blood loss, time for post-anesthesia care unit (PACU) discharge, postoperative pain, mean difference in heart rate (HR), and mean difference in mean arterial pressure (MAP). Continuous data were pooled as mean difference (MD) or standardized mean difference (SMD) via RevMan software. Also, the certainty of evidence for each outcome were assessed according to the GRADE system.
RESULTS: Four RCTs with total of 267 patients were included. Regarding the intraoperative quality of surgical field, the results indicated a significant difference in favor of the lidocaine group compared to the placebo group (n = 3 RCTs, MD - 0.80, 95% CI [- 0.98, - 0.61], p < 0.001, moderate certainty of evidence). The
trial sequential analysis showed there is a substantial and conclusive evidence. Regarding time for PACU discharge, there was a significant difference that favor lidocaine group (p < 0.05). On the contrary, there was no significant difference between lidocaine and placebo groups in terms of operative duration, estimated blood loss, postoperative pain, mean change in MAP and HR, (p > 0.05).
CONCLUSIONS: Our review revealed that lidocaine infusion, compared with a placebo, significantly improved the surgical field and shortened the time required for PACU discharge. However, lidocaine did not reduce surgery time, estimated blood loss, postoperative pain, MAP, or HR.