Wang Lifeng, Dong Yucai, Zhang Jiling, Tan Hongwu
Department of Anesthesiology Department of Rehabilitation Department of Gastroenterology, Linyi People's Hospital, Shandong Province, China.
Medicine (Baltimore). 2017 Sep;96(37):e8007. doi: 10.1097/MD.0000000000008007.
It is unknown whether gabapentin is effective in reducing acute pain following laparoscopic cholecystectomy. The purpose of the current meta-analysis was to evaluate the efficacy of gabapentin in reducing pain intensity and postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy.
All randomized controlled trials (RCTs) evaluating the efficacy of gabapentin in reducing pain intensity and PONV after laparoscopic cholecystectomy were searched on the following databases: PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Google database, the Chinese Wanfang database, and the China National Knowledge Infrastructure (CNKI). The most recent literature search was conducted on March 21, 2017. Outcomes including visual analog scale (VAS) at 12 and 24 hours, total morphine consumption, and the occurrence of PONV. Continuous outcomes were expressed as the weighted mean difference (WMD) and 95% confidence interval (CI), and the one discontinuous outcome was expressed as risk ratio (RR) and 95% CI. Stata 12.0 software was used for meta-analysis.
A total of 9 studies involving 966 patients were identified. In total, there were 484 gabapentin subjects and 482 controls. Compared with the control group, gabapentin was associated with lower VAS at 12 hours (WMD = -10.18, 95% CI: -17.36 to -2.80, P = .007) and 24 hours (WMD = -6.33, 95% CI: -8.41 to -4.25, P = .000), which was equivalent on a 110-point VAS scale to 10.18 points at 12 hours and 6.33 points at 24 hours. Compared with the control group, gabapentin was associated with less total morphine consumption by approximately 110.83 mg (WMD = -110.83, 95% CI: -183.25 to -38.42, P = .003). In addition, the occurrence of nausea and vomiting in gabapentin was decreased (25.2% vs 47.6, RR = 0.53, 95% CI: 0.44-0.63, P = .000).
Gabapentin was efficacious in reducing postoperative pain, total morphine consumption, and morphine-related complications following laparoscopic cholecystectomy. In addition, there was a negative correlation between the gabapentin dosage and the occurrence of nausea and vomiting. The number of included studies is limited, and more studies are needed to verify the effects of gabapentin in laparoscopic cholecystectomy patients.
加巴喷丁是否能有效减轻腹腔镜胆囊切除术后的急性疼痛尚不清楚。本荟萃分析的目的是评估加巴喷丁在减轻腹腔镜胆囊切除术后疼痛强度及术后恶心呕吐（PONV）方面的疗效。
在以下数据库中检索所有评估加巴喷丁在减轻腹腔镜胆囊切除术后疼痛强度及PONV方面疗效的随机对照试验（RCT）：PubMed、EMBASE、Cochrane对照试验中心注册库（CENTRAL）、谷歌数据库、中国万方数据库和中国知网（CNKI）。最近一次文献检索于2017年3月21日进行。观察指标包括术后12小时和24小时的视觉模拟评分（VAS）、吗啡总消耗量以及PONV的发生情况。连续型观察指标以加权均数差（WMD）和95%置信区间（CI）表示，单项非连续型观察指标以风险比（RR）和95%CI表示。使用Stata 12.0软件进行荟萃分析。
共纳入9项研究，涉及966例患者；其中加巴喷丁组484例，对照组482例。与对照组相比，加巴喷丁组术后12小时（WMD = -10.18，95%CI：-17.36至-2.80，P = 0.007）和24小时（WMD = -6.33，95%CI：-8.41至-4.25，P = 0.000）的VAS评分更低，在110分的VAS量表上分别相当于术后12小时降低10.18分，24小时降低6.33分。与对照组相比，加巴喷丁组的吗啡总消耗量减少约110.83mg（WMD = -110.83，95%CI：-183.25至-38.42，P = 0.003）。此外，加巴喷丁组恶心呕吐的发生率降低（25.2%对47.6%，RR = 0.53，95%CI：0.44 - 0.63，P = 0.000）。
加巴喷丁在减轻腹腔镜胆囊切除术后的疼痛、吗啡总消耗量及吗啡相关并发症方面有效。此外，加巴喷丁剂量与恶心呕吐的发生呈负相关。纳入研究的数量有限，需要更多研究来验证加巴喷丁对腹腔镜胆囊切除术患者的影响。
