Lam David M H, Choi Siu-Wai, Wong Stanley S C, Irwin Michael G, Cheung Chi-Wai
From the Department of Anaesthesiology, Queen Mary Hospital (DMHL, MGI); and Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, The University of Hong Kong, Hong Kong, China (S-WC, SSCW, C-WC).
Medicine (Baltimore). 2015 Nov;94(46):e1944. doi: 10.1097/MD.0000000000001944.
The efficacy of pregabalin in acute postsurgical pain has been demonstrated in numerous studies; however, the analgesic efficacy and adverse effects of using pregabalin in various surgical procedures remain uncertain. We aim to assess the postsurgical analgesic efficacy and adverse events after pregabalin administration under different surgical categories using a systematic review and meta-analysis of randomized controlled trials.A search of the literature was performed between August 2014 to April 2015, using PubMed, Ovid via EMBASE, Google Scholar, and ClinicalTrials.gov with no limitation on publication year or language. Studies considered for inclusion were randomized controlled trials, reporting on relevant outcomes (2-, 24-hour pain scores, or 24 hour morphine-equivalent consumption) with treatment with perioperative pregabalin.Seventy-four studies were included. Pregabalin reduced pain scores at 2 hours in all categories: cardiothoracic (Hedge's g and 95%CI, -0.442 [-0.752 to -0.132], P = 0.005), ENT (Hedge g and 95%CI, -0.684 [-1.051 to -0.316], P < 0.0001), gynecologic (Hedge g, 95%CI, -0.792 [-1.235 to -0.350], P < 0.0001), laparoscopic cholecystectomy (Hedge g, 95%CI, -0.600 [-0.989 to -0.210], P = 0.003), orthopedic (Hedge g, 95%CI, -0.507 [-0.812 to -0.202], P = 0.001), spine (Hedge g, 95%CI, -0.972 [-1.537 to -0.407], P = 0.001), and miscellaneous procedures (Hedge g, 95%CI, -1.976 [-2.654 to -1.297], P < 0.0001). Pregabalin reduced 24-hour morphine consumption in gynecologic (Hedge g, 95%CI, -1.085 [-1.582 to -0.441], P = 0.001), laparoscopic cholecystectomy (Hedge g, 95%CI, -0.886 [-1.652 to -0.120], P = 0.023), orthopedic (Hedge g, 95%CI, -0.720 [-1.118 to -0.323], P < 0.0001), spine (Hedge g, 95%CI, -1.016 [-1.732 to -0.300], P = 0.005), and miscellaneous procedures (Hedge g, 95%CI, -1.329 [-2.286 to -0.372], P = 0.006). Pregabalin resulted in significant sedation in all surgical categories except ENT, laparoscopic cholecystectomy, and gynecologic procedures. Postoperative nausea and vomiting was only significant after pregabalin in miscellaneous procedures.Analgesic effects and incidence of adverse effects of using pregabalin are not equal in different surgical categories.
众多研究已证实普瑞巴林在急性术后疼痛治疗中的疗效；然而，在各种外科手术中使用普瑞巴林的镇痛效果及不良反应仍不明确。我们旨在通过对随机对照试验进行系统评价和荟萃分析，评估不同外科手术类别中使用普瑞巴林后的术后镇痛效果及不良事件。于2014年8月至2015年4月期间进行文献检索，使用了PubMed、通过EMBASE检索的Ovid、谷歌学术以及ClinicalTrials.gov，对发表年份和语言均无限制。纳入的研究为随机对照试验，报告围手术期使用普瑞巴林治疗后的相关结局（2小时、24小时疼痛评分或24小时吗啡等效用量）。共纳入74项研究。普瑞巴林在所有类别中均降低了2小时时的疼痛评分：心胸外科手术（Hedge's g及95%可信区间，-0.442 [-0.752至-0.132]，P = 0.005）、耳鼻喉科手术（Hedge g及95%可信区间，-0.684 [-1.051至-0.316]，P < 0.0001）、妇科手术（Hedge g，95%可信区间，-0.792 [-1.235至-0.350]，P < 0.0001）、腹腔镜胆囊切除术（Hedge g，95%可信区间，-0.600 [-0.989至-0.210]，P = 0.003）、骨科手术（Hedge g，95%可信区间，-0.507 [-0.812至-0.202]，P = 0.001）、脊柱手术（Hedge g，95%可信区间，-0.972 [-1.537至-0.407]，P = 0.001）以及其他各类手术（Hedge g，95%可信区间，-1.976 [-2.654至-1.297]，P < 0.0001）。普瑞巴林降低了妇科手术（Hedge g，95%可信区间，-1.085 [-1.582至-0.441]，P = 0.001）、腹腔镜胆囊切除术（Hedge g，95%可信区间，-0.886 [-1.652至-0.120]，P = 0.023）、骨科手术（Hedge g，95%可信区间，-0.720 [-1.118至-0.323]，P < 0.0001）、脊柱手术（Hedge g，95%可信区间，-1.016 [-1.732至-0.300]，P = 0.005）以及其他各类手术（Hedge g，95%可信区间，-1.329 [-2.286至-0.372]，P = 0.006）的24小时吗啡用量。除耳鼻喉科手术、腹腔镜胆囊切除术和妇科手术外，普瑞巴林在所有外科手术类别中均导致显著的镇静作用。仅在其他各类手术中，普瑞巴林使用后术后恶心呕吐显著。在不同外科手术类别中，使用普瑞巴林的镇痛效果及不良反应发生率并不相同。
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