Arruda Ana Paula Nappi, Zhang Yuchen, Gomaa Huda, Bergamaschi Cristiane de Cássia, Guimaraes Caio Chaves, Righesso Leonardo A R, Paglia Mariana Del Grossi, Barberato-Filho Silvio, Lopes Luciane Cruz, Ayala Melendez Ana Patricia, de Oliveira Luciane Dias, Paula-Ramos Lucas, Johnston Bradley, El Dib Regina
Department of Surgery and Orthopedics, UNESP - Universidade Estadual Paulista, Faculty of Medicine, Botucatu, São Paulo, Brazil.
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
BMJ Open. 2019 May 24;9(5):e023729. doi: 10.1136/bmjopen-2018-023729.
To summarise the effects of herbal medications for the prevention of anxiety, depression, pain, and postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic, obstetrical/gynaecological or cardiovascular surgical procedures.
Searches of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and LILACS up until January 2018 were performed to identify randomised controlled trials (RCTs). We included RCTs or quasi-RCTs evaluating any herbal medication among adults undergoing laparoscopic, obstetrical/gynaecological or cardiovascular surgeries. The primary outcomes were anxiety, depression, pain and PONV. We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate overall certainty of the evidence for each outcome.
Eleven trials including 693 patients were eligible. Results from three RCTs suggested a statistically significant reduction in vomiting (relative risk/risk ratio (RR) 0.57; 95% CI 0.38 to 0.86) and nausea (RR 0.69; 95% CI 0.50 to 0.96) with the use of (ginger) compared with placebo in both laparoscopic and obstetrical/gynaecological surgeries. Results suggested a non-statistically significantly reduction in the need for rescue medication for pain (RR 0.52; 95% CI 0.13 to 2.13) with (damask rose) and ginger compared with placebo in laparoscopic and obstetrical/gynaecological surgery. None of the included studies reported on adverse events (AEs).
There is very low-certainty evidence regarding the efficacy of both and in reducing vomiting (200 fewer cases per 1000; 288 fewer to 205 fewer), nausea (207 fewer cases per 1000; 333 fewer to 27 fewer) and the need for rescue medication for pain (666 fewer cases per 1000; 580 fewer to 752 more) in patients undergoing either laparoscopic or obstetrical/gynaecological surgeries. Among our eligible studies, there was no reported evidence on AEs.
CRD42016042838.
总结草药药物对接受腹腔镜、妇产科或心血管外科手术患者预防焦虑、抑郁、疼痛及术后恶心呕吐（PONV）的效果。
检索截至2018年1月的MEDLINE、EMBASE、Cochrane对照试验中心注册库和LILACS，以识别随机对照试验（RCT）。我们纳入了评估接受腹腔镜、妇产科或心血管手术的成年人中任何草药药物的RCT或准RCT。主要结局为焦虑、抑郁、疼痛和PONV。我们采用推荐评估、制定与评价分级方法对每个结局证据的总体确定性进行评级。
11项试验（包括693例患者）符合条件。3项RCT的结果表明，在腹腔镜和妇产科手术中，与安慰剂相比，使用生姜可使呕吐（相对危险度/风险比（RR）0.57；95%可信区间0.38至0.86）和恶心（RR ～ 0.69；95%可信区间0.50至0.96）在统计学上显著减少。结果表明，在腹腔镜和妇产科手术中，与安慰剂相比，使用大马士革玫瑰和生姜可使疼痛急救药物需求在统计学上非显著减少（RR 0.52；95%可信区间0.13至2.13）。纳入的研究均未报告不良事件（AE）。
关于生姜和大马士革玫瑰在减少接受腹腔镜或妇产科手术患者的呕吐（每1000例少200例；少288例至少205例）、恶心（每1000例少207例；少333例至少27例）以及疼痛急救药物需求（每1000例少666例；少580例至多752例）方面的疗效，证据的确定性非常低。在我们符合条件的研究中，没有关于AE的报告证据。
PROSPERO注册号：CRD42016042838。
