Zhai Lifeng, Song Zhoufeng, Liu Kang
From the Department of Orthopaedics (LZ), Tongde Hospital of Zhejiang Province; Department of Orthopaedics (ZS), Zhejiang Provincial Hospital of Traditional Chinese Medicine; and Department of Orthopaedics (KL), Second Hospital Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, Zhejiang, China.
Medicine (Baltimore). 2016 May;95(20):e3673. doi: 10.1097/MD.0000000000003673.
The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) and non-RCTs was to evaluate the efficacy and safety of gabapentin versus placebo for pain control after total knee arthroplasty (TKA).In December 2015, a systematic computer-based search was conducted in the Medline, Embase, PubMed, Cochrane Controlled Trials Register (CENTRAL), Web of Science, Google, and Chinese Wanfang databases. This systematic review and meta-analysis were performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement criteria. The primary endpoint was the visual analogue scale (VAS) score after TKA with rest or mobilization at 24 and 48 hours, representing the efficacy of pain control after TKA. Cumulative morphine consumption via patient controlled anesthesia (PCA) was also assessed to determine the morphine-spare effect. Complications such as dizziness, pruritus, vomiting, nausea, and sedation were also compiled to assess the safety of gabapentin. Stata 12.0 software was used for the meta-analysis. After testing for publication bias and heterogeneity across studies, the data were aggregated for random-effects modeling whenever necessary.Six studies involving 769 patients met the inclusion criteria. Our meta-analysis revealed that gabapentin resulted in superior pain relief compared to the control group in terms of VAS score with rest at 24 hours (mean difference [MD] = -3.47; 95% confidence interval [CI] -6.16 to -0.77; P = 0.012) and at 48 hours postoperatively (MD = -2.25; 95% CI -4.21 to -0.30; P = 0.024). There was no statistically significant difference between the groups with respect to the VAS score at 24 hours postoperatively (MD = 1.05; 95% CI -3.31 to 5.42; P = 0.636) or at 48 hours (MD = 1.71; 95% CI -0.74 to 4.15; P = 0.171). These results indicated that the perioperative administration of gabapentin decreases the cumulative morphine consumption via PCA at 24 hours (MD = -8.28; 95% CI -12.57 to -3.99; P = 0.000) and 48 hours (MD = -4.50; 95% CI -10.98 to -3.61; P = 0.221). Furthermore, gabapentin decreased the rate of postoperative dizziness (relative risk [RR], 0.68; 95% CI 0.47-0.99, P = 0.044) and the occurrence of pruritus (RR, 0.50; 95% CI 0.37-0.67, P = 0.000).Based on the current meta-analysis, gabapentin exerts an analgesic and opioid-sparing effect in acute postoperative pain management without increasing the rate of dizziness and pruritus.
本系统评价和对随机对照试验（RCT）及非随机对照试验的荟萃分析旨在评估加巴喷丁与安慰剂在全膝关节置换术（TKA）后疼痛控制方面的疗效和安全性。2015年12月，我们在Medline、Embase、PubMed、Cochrane对照试验注册库（CENTRAL）、科学网、谷歌以及中国万方数据库中进行了基于计算机的系统检索。本系统评价和荟萃分析按照系统评价和荟萃分析的首选报告项目（PRISMA）声明标准进行。主要终点是TKA术后24小时和48小时静息或活动时的视觉模拟量表（VAS）评分，代表TKA术后疼痛控制的疗效。还评估了通过患者自控镇痛（PCA）的累积吗啡消耗量，以确定吗啡节省效应。还汇总了头晕、瘙痒、呕吐、恶心和镇静等并发症，以评估加巴喷丁的安全性。使用Stata 12.0软件进行荟萃分析。在对各研究进行发表偏倚和异质性检验后，必要时对数据进行汇总以进行随机效应模型分析。六项涉及769例患者的研究符合纳入标准。我们的荟萃分析显示，在术后24小时静息时的VAS评分方面（平均差[MD]= -3.47；95%置信区间[CI] -6.16至-0.77；P = 0.012）以及术后48小时（MD = -2.25；95% CI -4.21至-0.30；P = 0.024），加巴喷丁组的疼痛缓解优于对照组。术后24小时（MD = 1.05；95% CI -3.31至5.42；P = 0.636）或48小时（MD = 1.71；95% CI -0.74至4.15；P = 0.171）两组间VAS评分无统计学显著差异。这些结果表明，围手术期给予加巴喷丁可降低术后24小时（MD = -8.28；95% CI -12.57至-3.99；P = 0.000）和48小时（MD = -4.50；95% CI -10.98至-3.61；P = 0.221）通过PCA的累积吗啡消耗量。此外，加巴喷丁降低了术后头晕发生率（相对危险度[RR]，0.68；95% CI 0.47 - 0.99，P = 0.044）和瘙痒发生率（RR，0.50；95% CI 0.37 - 0.67，P = 0.000）。基于当前的荟萃分析，加巴喷丁在急性术后疼痛管理中发挥镇痛和节省阿片类药物的作用，且不增加头晕和瘙痒发生率。
