术前使用普瑞巴林对术后恶心呕吐的影响：一项荟萃分析。

The Effect of Preoperative Pregabalin on Postoperative Nausea and Vomiting: A Meta-analysis.

作者信息

Grant Michael C, Betz Matthew, Hulse Matthew, Zorrilla-Vaca Andres, Hobson Deborah, Wick Elizabeth, Wu Christopher L

机构信息

From *The Johns Hopkins Medical Institutions, Baltimore, Maryland; †Vanderbilt University Hospital, Nashville, Tennessee; and ‡Hospital Universitario del Valle, Universidad del Valle, Valle del Cauca, Colombia.

出版信息

Anesth Analg. 2016 Nov;123(5):1100-1107. doi: 10.1213/ANE.0000000000001404.

DOI:10.1213/ANE.0000000000001404

PMID:27464972

Abstract

BACKGROUND

Nonopioid adjuvant medications are increasingly included among perioperative Enhanced Recovery After Surgery protocols. Preoperative pregabalin has been shown to improve postoperative pain and limit reliance on opioid analgesia. Our group investigated the ability of preoperative pregabalin to also prevent postoperative nausea and vomiting (PONV).

METHODS

Our group performed a meta-analysis of randomized trials that report outcomes on the effect of preoperative pregabalin on PONV endpoints in patients undergoing general anesthesia.

RESULTS

Among all included trials (23 trials; n = 1693), preoperative pregabalin was associated with a significant reduction in PONV (risk ratio [RR] = 0.53; 95% confidence interval [CI], 0.39-0.73; P = 0.0001), nausea (RR = 0.62; 95% CI, 0.46-0.83; P = 0.002), and vomiting (RR = 0.68; 95% CI, 0.52-0.88; P = 0.003) at 24 hours. Subgroup analysis designed to account for major PONV confounders, including the exclusion trials with repeat dosing, thiopental induction, nitrous oxide maintenance, and prophylactic antiemetics and including high-risk surgery, resulted in similar antiemetic efficacy. Preoperative pregabalin is also associated with significantly increased rates of postoperative visual disturbance (RR = 3.11; 95% CI, 1.34-7.21; P = 0.008) compared with a control.

CONCLUSIONS

Preoperative pregabalin is associated with significant reduction of PONV and should not only be considered as part of a multimodal approach to postoperative analgesia but also for prevention of PONV.

摘要

背景

非阿片类辅助药物越来越多地被纳入围手术期术后加速康复方案中。术前使用普瑞巴林已被证明可改善术后疼痛并减少对阿片类镇痛药物的依赖。我们的研究小组调查了术前使用普瑞巴林预防术后恶心和呕吐（PONV）的能力。

方法

我们的研究小组对随机试验进行了荟萃分析，这些试验报告了术前普瑞巴林对接受全身麻醉患者PONV终点的影响。

结果

在所有纳入的试验（23项试验；n = 1693）中，术前使用普瑞巴林与PONV显著降低相关（风险比[RR] = 0.53；95%置信区间[CI]，0.39 - 0.73；P = 0.0001），恶心（RR = 0.62；95% CI，0.46 - 0.83；P = 0.002）和呕吐（RR = 0.68；95% CI，0.52 - 0.88；P = 0.003）在24小时时出现的情况。旨在考虑主要PONV混杂因素的亚组分析，包括排除重复给药、硫喷妥钠诱导、氧化亚氮维持和预防性使用止吐药的试验以及纳入高风险手术，结果显示抗呕吐疗效相似。与对照组相比，术前使用普瑞巴林还与术后视觉障碍发生率显著增加相关（RR = 3.11；95% CI，1.34 - 7.21；P = 0.008）。