Yu Xiaoyun, Wang Jiyun, Huang Lizhen, Yu Xiao, He Zheyun
Department of Otorhinolaryngology, Ningbo No.2 Hospital, Zhejiang, China.
Am J Rhinol Allergy. 2016 Sep 30;30(5):176-180. doi: 10.2500/ajra.2016.30.4357. Epub 2016 Jun 30.
To assess the efficacy and safety of bupivacaine compared with lidocaine in local anesthesia of nasopharynx through meta-analysis.
A number of medical literature data bases were searched electronically. Relevant journals and references of included studies were manually searched. Two reviewers independently performed data extraction and quality assessment.
Four studies were included. Visual analog scale (VAS) scores, acceptable discomfort, and bleeding scores were analyzed for bupivacaine versus lidocaine. When considering the VAS scores, bupivacaine as a local anesthetic agent was better than lidocaine in controlling the pain of postoperative patients (p < 0.00001). From VAS scores of patients for transnasal fiberoptic nasopharyngolaryngoscopic examination that was performed to evaluate upper airway structures, lidocaine was found to be better at pain management in patients who underwent transnasal endoscopic examination (p < 0.00001). However, when analyzing the acceptable discomfort of patients who underwent upper gastrointestinal endoscopy, which serves as a valuable tool to evaluate upper gastrointestinal structures, the patients in the bupivacaine group demonstrated a higher acceptable discomfort than the patients in the lidocaine group (p = 0.008). With regard to the bleeding scores of the patients with nasal surgery, lidocaine was better at bleeding in postoperative patients compared with bupivacaine (p = 0.0007). These results indicated that bupivacaine showed better pain control of postoperative patients and acceptable discomfort in patients with upper gastrointestinal endoscopy. Lidocaine had a significantly increased ability the pain of patients with transnasal fiberoptic nasopharyngolaryngoscopic examination and bleeding in postoperative patients. No systemic adverse events were reported.
Bupivacaine was found to have better promotion to pain control than did lidocaine for the patients after nasal surgery. Lidocaine had a significantly increased inhibition of bleeding in these postoperative patients; however, the efficacy between bupivacaine and lidocaine was unclear for the patients who had transnasal endoscopic examinations.
通过荟萃分析评估布比卡因与利多卡因在鼻咽部局部麻醉中的疗效和安全性。
通过电子检索多个医学文献数据库。人工检索纳入研究的相关期刊和参考文献。两名评价者独立进行数据提取和质量评估。
纳入四项研究。分析了布比卡因与利多卡因的视觉模拟量表（VAS）评分、可接受的不适程度和出血评分。在考虑VAS评分时，布比卡因作为局部麻醉剂在控制术后患者疼痛方面优于利多卡因（p<0.00001）。从用于评估上气道结构的经鼻纤维鼻咽喉镜检查患者的VAS评分来看，利多卡因在经鼻内镜检查患者的疼痛管理方面表现更好（p<0.00001）。然而，在分析作为评估上消化道结构的重要工具的上消化道内镜检查患者的可接受不适程度时，布比卡因组患者的可接受不适程度高于利多卡因组患者（p = 0.008）。关于鼻手术患者的出血评分，利多卡因在术后患者出血控制方面优于布比卡因（p = 0.0007）。这些结果表明，布比卡因在术后患者的疼痛控制方面表现更好，在上消化道内镜检查患者中可接受的不适程度也较好。利多卡因在经鼻纤维鼻咽喉镜检查患者的疼痛控制和术后患者出血方面的能力显著增强。未报告全身性不良事件。
发现布比卡因比利多卡因对鼻手术后患者的疼痛控制有更好的促进作用。利多卡因对这些术后患者的出血抑制作用显著增强；然而，对于经鼻内镜检查的患者，布比卡因和利多卡因之间的疗效尚不清楚。
