Wang Yi-Ming, Xia Min, Shan Nan, Yuan Ping, Wang Dong-Lin, Shao Jiang-He, Ma Hui-Wen, Wang Lu-Lu, Zhang Yuan
Department of Oncology, Chongqing Cancer Institute & Hospital & Cancer Center Department of Gynaecology, Chongqing Traditional Chinese Medicine Hospital Department of Obstetrics and Gynecology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China.
Medicine (Baltimore). 2017 Aug;96(31):e7714. doi: 10.1097/MD.0000000000007714.
BACKGROUND: Whether the preoperative administration of pregabalin plays a beneficial role in controlling acute pain after hysterectomy is unknown. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the efficacy and safety of the preoperative use of pregabalin to treat acute postoperative pain following hysterectomy. METHODS: In April 2017, a systematic computer-based search was conducted in the PubMed, EMBASE, Web of Science, Cochrane Library, and Google databases. RCTs comparing pregabalin with placebo in patients undergoing hysterectomy were retrieved. The primary endpoint was the visual analog scale (VAS) score with rest or mobilization at 2 h, 4 and 24 hours and cumulative morphine consumption at 2, 4, 24, and 48 hours. The secondary outcomes were complications of nausea, vomiting, sedation, and dizziness. After tests for publication bias and heterogeneity among studies were performed, the data were aggregated for random-effects models when necessary. RESULTS: Ten clinical studies with 1207 patients (pregabalin = 760, control = 447) were finally included in this meta-analysis. Preoperative administration of pregabalin was associated with a significant reduction of VAS with rest or mobilization at 2, 4, and 24 hours after hysterectomy. Further, the preoperative administration of pregabalin was associated with a reduction in total morphine consumption at 2, 4, 24, and 48 hours after hysterectomy. The occurrence of morphine-related complications (nausea and vomiting) was also reduced in the pregabalin group. However, the preoperative administration of pregabalin was associated with an increase in the occurrence of dizziness. There was no significant difference in the occurrence of sedation. CONCLUSIONS: The preoperative use of pregabalin reduced postoperative pain, total morphine consumption, and morphine-related complications following hysterectomy. The doses of pregabalin were different, and large heterogeneity was the limitation of the current meta-analysis. Further studies should determine the optimal dose for controlling acute pain after hysterectomy.
背景：术前给予普瑞巴林在控制子宫切除术后急性疼痛方面是否发挥有益作用尚不清楚。我们进行了一项随机对照试验（RCT）的系统评价和荟萃分析，以确定术前使用普瑞巴林治疗子宫切除术后急性疼痛的疗效和安全性。 方法：2017年4月，在PubMed、EMBASE、科学网、Cochrane图书馆和谷歌数据库中进行了基于计算机的系统检索。检索了在接受子宫切除术的患者中比较普瑞巴林与安慰剂的随机对照试验。主要终点是术后2小时、4小时和24小时静息或活动时的视觉模拟量表（VAS）评分，以及术后2小时、4小时、24小时和48小时的吗啡累积消耗量。次要结局是恶心、呕吐、镇静和头晕的并发症。在对研究间的发表偏倚和异质性进行检验后，必要时将数据汇总用于随机效应模型。 结果：本荟萃分析最终纳入了10项临床研究，共1207例患者（普瑞巴林组=760例，对照组=447例）。术前给予普瑞巴林与子宫切除术后2小时、4小时和24小时静息或活动时VAS评分显著降低相关。此外，术前给予普瑞巴林与子宫切除术后2小时、4小时、24小时和48小时吗啡总消耗量减少相关。普瑞巴林组吗啡相关并发症（恶心和呕吐）的发生率也有所降低。然而，术前给予普瑞巴林与头晕发生率增加相关。镇静发生率无显著差异。 结论：术前使用普瑞巴林可减轻子宫切除术后的疼痛、吗啡总消耗量及吗啡相关并发症。普瑞巴林的剂量不同，且异质性大是当前荟萃分析的局限性。进一步的研究应确定控制子宫切除术后急性疼痛的最佳剂量。
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