Li Shijie, Guo Junqiang, Li Fangjun, Yang Zhijia, Wang Shuai, Qin Changjiang
Department of Trauma Emergency Department of General Surgery, Huaihe Hospital, Henan University, Kaifeng, China.
Medicine (Baltimore). 2017 May;96(21):e6982. doi: 10.1097/MD.0000000000006982.
Pregabalin has been used as an adjunct for the management of acute pain in laparoscopic cholecystectomy. This meta-analysis aimed to illustrate the efficacy and safety of pregabalin for pain management following laparoscopic cholecystectomy.
In March 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and Google databases. Data on patients prepared for laparoscopic cholecystectomy in studies that compared pregabalin versus placebo were retrieved. The primary endpoints were the visual analog scale (VAS) score with rest or mobilization at 6, 12, and 24 hours and total morphine consumption. The secondary outcomes were the morphine-related complications (i.e., nausea, vomiting, dizziness, somnolence, headache, pruritus, urine retention, respiratory depression, and blurred vision). Continuous outcomes were expressed as the weighted mean difference (WMD) with a corresponding 95% confidence interval (CI), and discontinuous outcomes were expressed as a risk ratio (RR) with a corresponding 95% CI.
Twelve clinical studies with 938 patients (gabapentin group = 536, control group = 402) were ultimately included in the meta-analysis. Pregabalin was associated with reduced pain scores with rest at 6, 12, and 24 hours, which corresponded to a reduction of 11.27 points at 6 hours, 9.46 points at 12 hours, and 3.99 points at 24 hours on a 100-point VAS. Moreover, pregabalin was associated with reduced pain scores with mobilization at 6, 12, and 24 hours, which corresponded to a reduction of 8.74 points, 5.80 points and 6.37 points at 6, 12, and 24 hours, respectively, on a 110-point VAS. Furthermore, pregabalin reduced the occurrence of nausea and vomiting. There were no significant differences in the occurrence of respiratory depression, pruritus, dizziness, blurred vision, and headache.
Pregabalin was efficacious in the reduction of postoperative pain, total morphine consumption, and morphine-related complications following laparoscopic cholecystectomy. In addition, a high dose of pregabalin was more effective than a low dose. The dose of pregabalin differed across the studies, and the heterogeneity was large. More studies are needed to verify the optimal dose of pregabalin in laparoscopic cholecystectomy patients.
普瑞巴林已被用作腹腔镜胆囊切除术中急性疼痛管理的辅助药物。本荟萃分析旨在阐明普瑞巴林在腹腔镜胆囊切除术后疼痛管理中的疗效和安全性。
2017年3月，在PubMed、EMBASE、科学网、Cochrane系统评价数据库和谷歌数据库中进行了基于计算机的系统检索。检索了比较普瑞巴林与安慰剂的研究中准备进行腹腔镜胆囊切除术患者的数据。主要终点是6、12和24小时静息或活动时的视觉模拟量表（VAS）评分以及吗啡总消耗量。次要结局是与吗啡相关的并发症（即恶心、呕吐、头晕、嗜睡、头痛、瘙痒、尿潴留、呼吸抑制和视力模糊）。连续结局以加权平均差（WMD）及相应的95%置信区间（CI）表示，非连续结局以风险比（RR）及相应的95%CI表示。
最终有12项临床研究（938例患者，加巴喷丁组 = 536例，对照组 = 402例）纳入荟萃分析。普瑞巴林与6、12和24小时静息时疼痛评分降低相关，在100分制VAS上，分别相当于6小时降低11.27分、12小时降低9.46分、24小时降低3.99分。此外，普瑞巴林与6、12和24小时活动时疼痛评分降低相关，在110分制VAS上，分别相当于6小时降低8.74分、12小时降低5.80分、24小时降低6.37分。此外，普瑞巴林减少了恶心和呕吐的发生。呼吸抑制、瘙痒、头晕、视力模糊和头痛的发生率无显著差异。
普瑞巴林在降低腹腔镜胆囊切除术后的疼痛、吗啡总消耗量及与吗啡相关的并发症方面有效。此外，高剂量普瑞巴林比低剂量更有效。各研究中普瑞巴林的剂量不同，异质性较大。需要更多研究来验证腹腔镜胆囊切除术患者普瑞巴林的最佳剂量。
