Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC 27710, USA.
Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC 27710, USA
Br J Anaesth. 2015 Jan;114(1):10-31. doi: 10.1093/bja/aeu293. Epub 2014 Sep 10.
We performed this systematic review to assess the analgesic efficacy of perioperative pregabalin. Subgroup analyses and meta-regression were performed to assess the impact of individual dose and frequency of pregabalin administration on analgesic efficacy. We included 55 studies. When all doses and administration regimens were combined, pregabalin was associated with a significant reduction in pain scores at rest and during movement and opioid consumption at 24 h compared with placebo {mean difference [95% confidence interval (CI)]=-0.38 (-0.57, -0.20), -0.47 (-0.76, -0.18), and -8.27 mg morphine equivalents (-10.08, -6.47), respectively}. Patients receiving pregabalin had less postoperative nausea and vomiting and pruritus compared with placebo [relative risk (RR) (95% CI)=0.62 (0.48, 0.80) and 0.49 (0.34, 0.70), respectively]. Sedation, dizziness, and visual disturbance were more common with pregabalin compared with placebo [RR (95% CI)=1.46 (1.08, 1.98), 1.33 (1.07, 1.64), and 3.52 (2.05, 6.04), respectively]. All doses of pregabalin tested (≤75, 100-150, and 300 mg) resulted in opioid sparing at 24 h after surgery. There were no significant differences in acute pain outcomes with pregabalin 100-300 mg between single preoperative dosing regimens and those including additional doses repeated after surgery. Data were insufficient to reach conclusions regarding persistent pain, but limited data available from two studies suggested that pregabalin might be effective for the reduction of neuropathic pain. In conclusion, this review suggests that pregabalin improves postoperative analgesia compared with placebo at the expense of increased sedation and visual disturbances.
我们进行了这项系统评价，以评估围手术期普瑞巴林的镇痛效果。进行了亚组分析和荟萃回归分析，以评估普瑞巴林的个体剂量和给药频率对镇痛效果的影响。我们纳入了 55 项研究。当所有剂量和给药方案合并时，与安慰剂相比，普瑞巴林可显著降低术后 24 小时静息时和运动时的疼痛评分以及阿片类药物的消耗量[均数差值（95%置信区间）=-0.38（-0.57，-0.20），-0.47（-0.76，-0.18）和-8.27mg 吗啡当量（-10.08，-6.47）]。与安慰剂相比，接受普瑞巴林治疗的患者术后恶心和呕吐以及瘙痒的发生率更低[相对风险（95%置信区间）=0.62（0.48，0.80）和 0.49（0.34，0.70）]。与安慰剂相比，普瑞巴林治疗组镇静、头晕和视觉障碍更为常见[相对风险（95%置信区间）=1.46（1.08，1.98）、1.33（1.07，1.64）和 3.52（2.05，6.04）]。所有测试剂量的普瑞巴林（≤75、100-150 和 300mg）均可在术后 24 小时减少阿片类药物的使用。在单次术前给药方案和包括术后重复给药的方案中，普瑞巴林 100-300mg 对急性疼痛结局均无显著差异。关于持续性疼痛，虽有来自两项研究的有限数据，但不足以得出结论，但这些数据表明普瑞巴林可能对减轻神经性疼痛有效。总之，本综述表明普瑞巴林可改善术后镇痛效果，与安慰剂相比，镇静和视觉障碍发生率增加。
