利多卡因预防小儿患者使用丙泊酚时疼痛发生率及严重程度的疗效：一项符合PRISMA标准的随机对照试验的荟萃分析。

Efficacy of lidocaine on preventing incidence and severity of pain associated with propofol using in pediatric patients: A PRISMA-compliant meta-analysis of randomized controlled trials.

作者信息

Lang Bing-Chen, Yang Chun-Song, Zhang Ling-Li, Zhang Wen-Sheng, Fu Yu-Zhi

机构信息

Department of Pharmacy, West China Second University Hospital, Sichuan University Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Evidence-Based Pharmacy Center, West China Second University Hospital Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China.

出版信息

Medicine (Baltimore). 2017 Mar;96(11):e6320. doi: 10.1097/MD.0000000000006320.

DOI:10.1097/MD.0000000000006320

PMID:28296748

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5369903/

Abstract

BACKGROUND

Propofol injection pain was considered as one conundrum during clinical anesthesia. The systematic review about the effect of lidocaine in reducing injection pain among children has not been established. The aim of the study was to systematically evaluate the efficacy and safety of such intervention.

METHODS

The literature search was performed from the inception to the May 31, 2016 in PubMed, Ovid EMBASE, and Cochrane database. All randomized controlled trials that using lidocaine for propofol injection pain in children were enrolled. The primary outcome included the incidence of injection pain and the incidence of propofol injection pain in different degrees. The data were combined to calculate the relative ratio and relevant 95% confidence interval. A meta-analysis was performed following the guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement.

RESULTS

Data from the included 11 studies indicated that the incidence of injection pain was lower in lidocaine group than the incidence in saline control group and in propofol lipuro (medium- and long-chain triglycerides) group (pain occurrence: 22.1% in lidocaine vs 66.8% in saline, RR with 95% 0.34 [0.26, 0.43], I = 38%; 30.5% in lidocaine vs 46.9% in propofol lipuro, RR with 95% 0.68 [0.46, 1.00], I = 9%). There was no difference between lidocaine and ketamine/alfentanil both in reducing pain occurrence and in reducing pain severity (pain occurrence: 29.7% in lidocaine vs 25.8% in ketamine, RR with 95% 1.47 [0.16, 13.43], I = 94%; 31.0% in lidocaine vs 30.7% in alfentanil, RR with 95% 1.01 [0.69, 1.46], I = 11%). And the reported side effects revealed that the safety of lidocaine in pediatric patients was acceptable.

CONCLUSION

Compared with ketamine and alfentanil, lidocaine would be served as one more effective treatment in consideration of its well-matched efficacy, acceptable accessibility, and reasonable safety. However, more high-quality evidences in pediatric patients are necessary.

摘要

背景

丙泊酚注射痛是临床麻醉中的一个难题。关于利多卡因在减轻儿童注射痛方面效果的系统评价尚未建立。本研究的目的是系统评价这种干预措施的有效性和安全性。

方法

从创刊至2016年5月31日在PubMed、Ovid EMBASE和Cochrane数据库中进行文献检索。纳入所有使用利多卡因减轻儿童丙泊酚注射痛的随机对照试验。主要结局包括注射痛的发生率以及不同程度丙泊酚注射痛的发生率。合并数据计算相对比值及相关的95%置信区间。按照Cochrane系统评价员手册和PRISMA声明的指南进行荟萃分析。

结果

纳入的11项研究的数据表明，利多卡因组的注射痛发生率低于生理盐水对照组和丙泊酚乳剂（中长链甘油三酯）组（疼痛发生率：利多卡因组为22.1%，生理盐水组为66.8%，RR为0.34[0.26,0.43]，I²=38%；利多卡因组为30.5%，丙泊酚乳剂组为46.9%，RR为0.68[0.46,1.00]，I²=9%）。利多卡因与氯胺酮/阿芬太尼在减轻疼痛发生率和疼痛严重程度方面均无差异（疼痛发生率：利多卡因组为29.7%，氯胺酮组为25.8%，RR为1.47[0.16,13.43]，I²=94%；利多卡因组为31.0%，阿芬太尼组为30.7%，RR为1.01[0.69,1.46]，I²=11%）。报告的副作用表明利多卡因在儿科患者中的安全性是可接受的。