Jiang Hai-Liang, Huang Shuang, Song Jiang, Wang Xiang, Cao Zhong-Shu
Department of Spinal Surgery Department of Anesthesiology, The Central Hospital of Zaozhuang Mining Group of Shandong Department of Spinal Surgery, Tengzhou Central People's Hospital, Zaozhuang, Shandong, China.
Medicine (Baltimore). 2017 Mar;96(11):e6129. doi: 10.1097/MD.0000000000006129.
BACKGROUND: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of pregabalin for pain management following spine surgery. METHODS: In September 2016, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews. RCTs of patients prepared for spine surgery that compared pregabalin with placebo were retrieved. The primary endpoint was the VAS score with rest or mobilization at 12 hours, 24 hours, and 48 hours and cumulative morphine consumption at 24 hours and 48 hours. The secondary outcomes were complications of nausea, sedation, dizziness, headache, and visual disturbances. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary. RESULTS: Ten clinical studies with 535 patients (pregabalin group = 294, control group = 241) were included in the meta-analysis. Pregabalin was associated with reduced pain scores at 12 hours, 24 hours, and 48 hours, corresponding to a reduction of 1.91 points (95% CI, -4.07 to 0.24 point) at 12 hours, 2.66 points (95% CI, -4.51 to -0.81 point) at 24 hours, and 4.33 points (95% confidence interval, -6.38 to -2.99 point) at 48 hours on a 100-point numeric rating scale. There was no significant difference between VAS scores with mobilization at 12 hours, 24 hours, or 48 hours. Similarly, pregabalin was associated with a reduction in cumulative morphine consumption at 24 hours (-7.07, 95% CI -9.84, -4.30) and 48 hours (-6.52, 95% CI -7.78, -5.25, P = 0.000). Furthermore, pregabalin can reduce the occurrence of nausea (RR 0.57, 95% CI 0.41, 0.79, P = 0.001, number needed to treat = 8.4). There were no significant differences in the occurrence of sedation, dizziness, headache, or visual disturbances. CONCLUSIONS: Preoperative use of pregabalin was efficacious in reduction of postoperative pain, total morphine consumption, and the occurrence of nausea following spine surgery. Because the sample size and the number of included studies were limited, a multicenter RCT is needed to identify the effects and optimal dose of pregabalin for reducing acute pain after spine surgery.
背景：我们进行了一项随机对照试验（RCT）的系统评价和荟萃分析，以评估普瑞巴林用于脊柱手术后疼痛管理的疗效和安全性。 方法：2016年9月，在PubMed、EMBASE、科学网和Cochrane系统评价数据库中进行了基于计算机的系统检索。检索了为脊柱手术做准备的患者中比较普瑞巴林与安慰剂的随机对照试验。主要终点是12小时、24小时和48小时静息或活动时的视觉模拟评分（VAS）以及24小时和48小时的吗啡累积消耗量。次要结局是恶心、镇静、头晕、头痛和视觉障碍等并发症。在检验研究之间的发表偏倚和异质性后，必要时将数据汇总用于随机效应模型。 结果：荟萃分析纳入了10项临床研究，共535例患者（普瑞巴林组 = 294例，对照组 = 241例）。普瑞巴林与12小时、24小时和48小时时疼痛评分降低相关，在100分数字评分量表上，12小时时降低1.91分（95%置信区间，-4.07至0.24分），24小时时降低2.66分（95%置信区间，-4.51至-0.81分），48小时时降低4.33分（95%置信区间，-6.38至-2.99分）。12小时、24小时或48小时活动时的VAS评分之间无显著差异。同样，普瑞巴林与24小时（-7.07，95%置信区间 -9.84，-4.30）和48小时（-6.52，95%置信区间 -7.78，-5.25，P = 0.000）吗啡累积消耗量减少相关。此外，普瑞巴林可降低恶心的发生率（风险比0.57，95%置信区间0.41，0.79，P = 0.001，需治疗人数 = 8.4）。镇静、头晕、头痛或视觉障碍的发生率无显著差异。 结论：脊柱手术前使用普瑞巴林在减轻术后疼痛、吗啡总消耗量和恶心发生率方面有效。由于样本量和纳入研究数量有限，需要进行多中心随机对照试验以确定普瑞巴林减轻脊柱手术后急性疼痛的效果和最佳剂量。
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