Peng Ke, Liu Hua-Yue, Wu Shao-Ru, Liu Hong, Zhang Zhao-Cai, Ji Fu-Hai
From the *Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China; †Department of Anesthesiology and Pain Medicine, University of California Davis Health System, Sacramento, California; and ‡Department of Intensive Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Anesth Analg. 2016 Oct;123(4):846-58. doi: 10.1213/ANE.0000000000001504.
Many studies have compared propofol-based anesthesia with inhalational anesthesia. Results from several studies have shown improved postoperative analgesia after propofol anesthesia, but other studies showed contradictory results. There are no large prospective studies that compare postoperative pain after propofol versus inhalational anesthesia. This meta-analysis was designed to focus on this question.
A systematic literature search for randomized controlled trials that compared propofol-based anesthesia with volatile agents-based anesthesia in adults undergoing surgery was conducted. Published data were pooled for the meta-analysis with Review Manager (ie, RevMan). The main outcomes included postoperative pain intensity, opioid consumption, need for rescue analgesics, and time to first analgesia.
Thirty-nine clinical trials with a combined subject population of 4520 patients came within the purview of this meta-analysis. The investigated volatile agents included isoflurane, sevoflurane, and desflurane. Compared with inhalational anesthetics, the propofol use was associated with a reduced postoperative pain intensity at rest at 30 minutes, 1 hour, and 12 hours (mean difference in pain scores, 30 minutes, -0.48 [visual analog scale, 0-10]; 99% confidence interval [CI], -1.07 to 0.12, P = 0.04) and reduced morphine-equivalent consumption 0 to 24 hours postoperatively (mean difference in morphine-equivalent consumption, -2.68 mg; 99% CI, -6.17 to 0.82; P = 0.05). Fewer patients required postoperative rescue analgesics during 0 to 24 hours after surgery under propofol anesthesia (risk ratio, 0.87; 99% CI, 0.74-1.03; P = 0.04). In addition, patients anesthetized with propofol required administration of postoperative analgesia later than those anesthetized with volatiles (mean difference in time to first analgesic administration, 6.12 minutes; 99% CI, 0.02-12.21; P = 0.01). Considering that Z statistic in RevMan 5.3 does not perform optimally in highly heterogeneous samples among groups or many combinations of groups with small sample sizes, a P value of <.01 was considered statistically significant. On the basis of this threshold, none of the aforementioned results are statistically significant.
The current results are affected by substantial heterogeneity, which makes it difficult to predict significant differences in postoperative pain control between propofol anesthesia and inhalational anesthesia. Further large, randomized controlled trials are needed to corroborate these results and to detect differences (if any) between propofol and inhalational anesthesia on postoperative pain.
许多研究比较了丙泊酚麻醉与吸入麻醉。多项研究结果显示丙泊酚麻醉后术后镇痛有所改善，但其他研究结果却相互矛盾。尚无大型前瞻性研究比较丙泊酚麻醉与吸入麻醉后的术后疼痛情况。本荟萃分析旨在聚焦这一问题。
对比较丙泊酚麻醉与挥发性药物麻醉的成人手术随机对照试验进行系统文献检索。将已发表的数据汇总用于使用Review Manager（即RevMan）进行的荟萃分析。主要结局包括术后疼痛强度、阿片类药物消耗量、急救镇痛药需求以及首次镇痛时间。
39项临床试验纳入本荟萃分析，受试对象共计4520例。所研究的挥发性药物包括异氟烷、七氟烷和地氟烷。与吸入麻醉药相比，使用丙泊酚与术后30分钟、1小时和12小时静息时疼痛强度降低相关（疼痛评分的平均差值，30分钟时为 -0.48 [视觉模拟评分，0 - 10]；99%置信区间[CI]，-1.07至0.12，P = 0.04），且术后0至24小时吗啡当量消耗量降低（吗啡当量消耗量的平均差值，-2.68 mg；99% CI，-6.17至0.82；P = 0.05）。丙泊酚麻醉下，术后0至24小时需要急救镇痛药的患者较少（风险比，0.87；99% CI，0.74 - 1.03；P = 0.04）。此外，丙泊酚麻醉的患者术后镇痛给药时间比挥发性药物麻醉的患者晚（首次镇痛给药时间的平均差值，6.12分钟；99% CI，0.02至12.21；P = 0.01）。鉴于RevMan 5.3中的Z统计量在组间高度异质性样本或样本量较小的组的多种组合中表现不佳，P值<0.01被认为具有统计学意义。基于此阈值，上述结果均无统计学意义。
当前结果受显著异质性影响，这使得难以预测丙泊酚麻醉与吸入麻醉在术后疼痛控制方面的显著差异。需要进一步开展大型随机对照试验来证实这些结果，并检测丙泊酚与吸入麻醉在术后疼痛方面的差异（如有）。
