普瑞巴林对全膝关节置换术后急性术后疼痛的影响：一项荟萃分析。

The effect of pregabalin on acute postoperative pain in patients undergoing total knee arthroplasty: A meta-analysis.

机构信息

Department of Orthopedics, Linyi People's Hospital, Linyi, 276003, PR China.

Department of Pharmacy, Linyi Cancer Hospital, Linyi, 276001, PR China.

出版信息

Int J Surg. 2016 Oct;34:148-160. doi: 10.1016/j.ijsu.2016.08.521. Epub 2016 Aug 26.

DOI:10.1016/j.ijsu.2016.08.521

PMID:27573693

Abstract

OBJECTIVE

The purpose of this systematic review and meta-analysis of randomised controlled trials (RCTs) was to evaluate the effect of pain control of pregabalin versus placebo after a total knee arthroplasty (TKA).

METHODS

The electronic databases: Medline, Embase, PubMed, CENTRAL (Cochrane Controlled Trials Register), Web of Science and Google were searched from inception to February 2016. This systematic review and meta-analysis were performed according to the PRISMA statement criteria. The primary endpoint was the visual analogue scale (VAS) after a TKA with rest or mobilization at 24 h and 48 h, which represents the effect of pain control after TKA. The cumulative morphine consumption is also assessed to the morphine-sparing effect. The complications of nausea, vomiting, dizziness and sedation were also compiled to assess the safety of pregabalin. Software Stata 12.0 was used for the meta-analysis. After testing for publication bias and heterogeneity across studies, data were aggregated for random-effects modelling when necessary.

RESULTS

Six clinical trials with 769 patients were used for the meta-analysis. The meta-analysis indicated that pregabalin can decrease the VAS with rest at 24 h (MD = -8.14; 95% CI -12.57 to -3.71; P < 0.001) and 48 h (MD = -7.34; 95% CI -11.65 to -3.02; P < 0.001). Pregabalin can decrease the VAS with mobilization at 24 h (MD = -6.56; 95% CI -10.45 to -2.66; P = 0.001) and 48 h (MD = -9.62; 95% CI -12.80 to -6.44; P < 0.001). The results indicated that perioperative pregabalin can decrease the cumulative morphine consumption at 24 h (SMD = -0.97; 95% CI -1.17 to -0.78; P < 0.001) and 48 h (MD = -2.23; 95% CI -2.48 to -1.97; P < 0.001). Moreover, pregabalin can decrease the occurrence of nausea and vomiting but increase the occurrence of dizziness and sedation.

CONCLUSION

Based on the current meta-analysis, pregabalin has an analgesic and opioid-sparing effect in acute postoperative pain management without increasing the rate of nausea, vomiting.

摘要

目的

本系统评价和荟萃分析旨在评估在全膝关节置换术（TKA）后，普瑞巴林对疼痛控制的效果，与安慰剂相比。

方法

电子数据库：Medline、Embase、PubMed、CENTRAL（Cochrane 对照试验登记处）、Web of Science 和 Google 从创建到 2016 年 2 月进行搜索。本系统评价和荟萃分析根据 PRISMA 声明标准进行。主要终点是 TKA 后休息或活动时 24 小时和 48 小时的视觉模拟量表（VAS），代表 TKA 后疼痛控制的效果。还评估了累积吗啡消耗量以评估吗啡节省效果。还编译了恶心、呕吐、头晕和镇静的并发症，以评估普瑞巴林的安全性。使用 Stata 12.0 软件进行荟萃分析。在测试研究之间的发表偏倚和异质性之后，当需要时，数据被汇总为随机效应模型。

结果

使用 769 名患者的 6 项临床试验进行荟萃分析。荟萃分析表明，普瑞巴林可以降低 24 小时休息时的 VAS（MD=-8.14；95%CI-12.57 至-3.71；P<0.001）和 48 小时休息时的 VAS（MD=-7.34；95%CI-11.65 至-3.02；P<0.001）。普瑞巴林可以降低 24 小时活动时的 VAS（MD=-6.56；95%CI-10.45 至-2.66；P=0.001）和 48 小时活动时的 VAS（MD=-9.62；95%CI-12.80 至-6.44；P<0.001）。结果表明，围手术期普瑞巴林可以降低 24 小时（SMD=-0.97；95%CI-1.17 至-0.78；P<0.001）和 48 小时（MD=-2.23；95%CI-2.48 至-1.97；P<0.001）的累积吗啡消耗量。此外，普瑞巴林可以降低恶心和呕吐的发生率，但增加头晕和镇静的发生率。