背景:本系统综述和网络荟萃分析的目的是评估腹腔镜胆囊切除术(LC)前给予不同超前镇痛措施对患者术后疼痛的有效性和安全性。
方法:我们在包括PubMed、WebofScience,Embase,和Cochrane图书馆截至2024年3月,并收集了本文在LC手术中定义的26种超前镇痛措施的相关研究数据。结果包括术后不同时间(2、6、12和24h)的视觉模拟评分(VAS),术后24小时内服用阿片类药物,第一次抢救镇痛的时间,术后恶心和呕吐(PONV)的发生率,以及术后头痛或头晕的发生率。
结果:纳入49篇文献,涉及5987例患者。网络荟萃分析显示,多模式镇痛,神经阻滞,普瑞巴林,与安慰剂相比,加巴喷丁和加巴喷丁显著降低了术后所有时间点的术后疼痛评分和术后阿片类药物用量.曲马多,普瑞巴林,加巴喷丁明显延长了首次抢救镇痛的时间。布洛芬是降低PONV发生率的最佳干预措施。曲马多可显著降低术后头痛或头晕的发生率。不同剂量普瑞巴林和加巴喷丁的亚组分析表明,与安慰剂相比,普瑞巴林(300毫克,150毫克)和加巴喷丁(600毫克,300毫克,和20mg/kg)都更有效,这些剂量之间的功效没有显着差异。更高的剂量增加PONV和术后头痛和头晕的发生率,加巴喷丁300mg具有较低的药物不良反应(ADR)发生率。
结论:超前镇痛可显著降低术后疼痛强度,阿片类药物的消费,延长了第一次抢救镇痛的时间,并降低PONV和术后头痛和头晕的发生率。多模式镇痛,神经阻滞,普瑞巴林,加巴喷丁均表现出良好的疗效。术前给予加巴喷丁300mg可显着降低术后疼痛和ADR发生率,建议用于LC的超前镇痛。
背景:PROSPEROCRD42024522185.
BACKGROUND: The purpose of this systematic review and network meta-analysis was to evaluate the efficacy and safety of different preemptive analgesia measures given before laparoscopic cholecystectomy (LC) for postoperative pain in patients.
METHODS: We conducted a comprehensive search in databases including PubMed, Web of Science, Embase, and the Cochrane Library up to March 2024, and collected relevant research data on the 26 preemptive analgesia measures defined in this article in LC surgery. Outcomes included postoperative Visual Analogue Scores (VAS) at different times (2, 6, 12, and 24 h), opioid consumption within 24 h post-operation, time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV), and incidence of postoperative headache or dizziness.
RESULTS: Forty-nine articles involving 5987 patients were included. The network meta-analysis revealed that multimodal analgesia, nerve blocks, pregabalin, and gabapentin significantly reduced postoperative pain scores at all postoperative time points and postoperative opioid consumption compared to placebo. Tramadol, pregabalin, and gabapentin significantly extended the time to first rescue analgesia. Ibuprofen was the best intervention for reducing PONV incidence. Tramadol significantly reduced the incidence of postoperative headache or dizziness. Subgroup analysis of different doses of pregabalin and gabapentin showed that compared to placebo, pregabalin (300 mg, 150 mg) and gabapentin (600 mg, 300 mg, and 20 mg/kg) were all more effective without significant differences in efficacy between these doses. Higher doses increased the incidence of PONV and postoperative headache and dizziness, with gabapentin 300 mg having a lower adverse drug reaction (ADR) incidence.
CONCLUSIONS: Preemptive analgesia significantly reduced postoperative pain intensity, opioid consumption, extended the time to first rescue analgesia, and decreased the incidence of PONV and postoperative headache and dizziness. Multimodal analgesia, nerve blocks, pregabalin, and gabapentin all showed good efficacy. Gabapentin 300 mg given preoperatively significantly reduced postoperative pain and ADR incidence, recommended for preemptive analgesia in LC.
BACKGROUND: PROSPERO CRD42024522185.