预防性使用加巴喷丁在腹式子宫切除术：系统评价和荟萃分析。
Preemptive use of gabapentin in abdominal hysterectomy: a systematic review and meta-analysis.
机构信息
Department of Obstetrics and Gynecology and Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada.
出版信息
Obstet Gynecol. 2014 Jun;123(6):1221-1229. doi: 10.1097/AOG.0000000000000289.
OBJECTIVE
To examine the evidence of preemptive use of gabapentin in abdominal hysterectomy.
DATA SOURCES
We conducted an electronic based search using the following databases: PubMed, EMBASE, Ovid MEDLINE, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials. The following medical subject heading terms, keywords, and their combinations were used: "postoperative pain, hysterectomy, gynecologic surgical procedures, gabapentin, preemptive analgesia, and preemptive anesthesia." We manually searched the reference lists of identified studies.
METHODS OF STUDY SELECTION
Randomized controlled trials of women who underwent a total abdominal hysterectomy, with or without bilateral salpingo-oophorectomy, under general anesthesia were examined. Only trials with preoperative dose of gabapentin were included.
TABULATION, INTEGRATION, AND RESULTS: The meta-analysis and systematic review were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Fourteen trials met the inclusion criteria. The pooled data consisted of 448 cases in the gabapentin group and 443 others in the control group. The 24-hour cumulative narcotic consumption and the visual analog scale scores at 24 hours postoperatively were used for postoperative pain assessment. There was a significant decrease in morphine consumption at 24 hours when gabapentin was administered before surgery (from 24.3-55.9 mg to 13.2-42.7 mg, standardized mean difference -0.69) as well before and after surgery (from 25.7-80 mg to 20.3-55 mg, standardized mean difference -1.45), respectively. Metaregression analysis showed that the effect of gabapentin in reducing morphine consumption (compared with placebo) at 24 hours was stronger in the preoperative only group than in the preoperative and postoperative groups. Preemptive gabapentin decreased visual analog scale from 9-42.7 to 2-25.3 (standardized mean difference -1.03, 95% confidence interval [CI] -1.36 to -0.71). Compared with the control group (16.1-96.7%), the rate of nausea was less in the gabapentin group (11.6-70%, relative risk 0.76, 95% CI 0.66-0.88).
CONCLUSION
Preemptive administration of gabapentin is effective in decreasing postoperative pain scores, narcotic consumption, and nausea, and vomiting.
LEVEL OF EVIDENCE
I.
目的
探讨在腹部子宫切除术时预先使用加巴喷丁的证据。
数据来源
我们使用以下数据库进行了基于电子的搜索：PubMed、EMBASE、Ovid MEDLINE、ClinicalTrials.gov 和 Cochrane 对照试验中心注册库。使用了以下医学主题词、关键词及其组合：“术后疼痛、子宫切除术、妇科手术、加巴喷丁、预防性镇痛、预防性麻醉”。我们还手动搜索了已确定研究的参考文献列表。
研究选择方法
检查了在全身麻醉下接受全子宫切除术（伴或不伴双侧输卵管卵巢切除术）的女性的随机对照试验。仅纳入了使用术前加巴喷丁剂量的试验。
表格、综合和结果：根据系统评价和荟萃分析的首选报告项目（PRISMA）声明进行了荟萃分析和系统评价。符合纳入标准的有 14 项试验。汇总数据包括加巴喷丁组 448 例和对照组 443 例。24 小时累积阿片类药物消耗量和术后 24 小时视觉模拟评分用于术后疼痛评估。与术前相比，手术前给予加巴喷丁时，24 小时吗啡消耗量显著减少（从 24.3-55.9mg 降至 13.2-42.7mg，标准化均数差 -0.69），术前和术后均减少（从 25.7-80mg 降至 20.3-55mg，标准化均数差 -1.45）。Meta 回归分析表明，与安慰剂相比，加巴喷丁在减少 24 小时吗啡消耗量方面的效果在仅术前组比术前和术后组更强。预防性加巴喷丁可使视觉模拟评分从 9-42.7 降至 2-25.3（标准化均数差-1.03，95%置信区间[CI] -1.36 至 -0.71）。与对照组（16.1-96.7%）相比，加巴喷丁组恶心发生率较低（11.6-70%，相对风险 0.76，95%CI 0.66-0.88）。
结论
预先给予加巴喷丁可有效降低术后疼痛评分、阿片类药物消耗和恶心呕吐发生率。
证据水平
I。
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