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单纯硬膜外布比卡因与布比卡因联合硫酸镁用于术后镇痛的比较评价：一项随机对照试验的荟萃分析。

Comparative evaluation of epidural bupivacaine alone and bupivacaine combined with magnesium sulfate in providing postoperative analgesia: a meta-analysis of randomized controlled trials.

机构信息

Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, People's Republic of China.

Department of Anesthesiology, Jilin University Second Hospital, No. 218 Ziqiang street, Changchun, Jilin, 130021, People's Republic of China.

出版信息

BMC Anesthesiol. 2020 Feb 5;20(1):39. doi: 10.1186/s12871-020-0947-8.

DOI:10.1186/s12871-020-0947-8
PMID:32024465
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7003447/
Abstract

BACKGROUND

The comparative efficacy of epidural bupivacaine alone and bupivacaine combined with magnesium sulfate in providing postoperative analgesia remains controversial.

METHODS

We searched Mediline (OvidSP), EMBASE (OvidSP) and Cochrane Central Register of Controlled Trials (CENTRAL) to identify trials that compared epidural bupivacaine and magnesium sulfate combination (intervention) with bupivacaine alone (control). Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework was used to assess the quality of evidence.

RESULTS

Eleven studies fulfilled our inclusion criteria after screening. We found that epidural bupivacaine combined with magnesium sulfate could prolong the time for first rescue analgesics (SMD 4.96; 95% CI [2.75, 7.17], P < 0.00001, I = 98%), reduce the number of patients who need rescue analgesics (RR 0.38; 95% CI [0.20, 0.74], P = 0.004, I = 75%) and requirement for rescue analgesics (SMD -2.65; 95% CI [- 4.23, - 1.06], P = 0.001, I = 96%).

CONCLUSIONS

Magnesium suifate as an adjuvant of epidural bupivacaine improved postoperative analgesia. However, we rated the quality of evidence to be very low because of high heterogeneity, imprecise of results and small sample sizes. Furthermore, further large high-quality trials are still needed to confirm the effects of magnesium sulfate on postoperative analgesia.

摘要

背景

布比卡因硬膜外单独使用与布比卡因联合硫酸镁用于术后镇痛的疗效比较仍存在争议。

方法

我们检索了 Mediline（OvidSP）、EMBASE（OvidSP）和 Cochrane 中央对照试验注册库（CENTRAL），以确定比较硬膜外布比卡因和硫酸镁联合（干预）与布比卡因单独使用（对照）的试验。采用推荐分级、评估、发展与评价（GRADE）框架评估证据质量。

结果

经过筛选，有 11 项研究符合我们的纳入标准。我们发现，布比卡因联合硫酸镁硬膜外给药可延长首次解救镇痛的时间（SMD 4.96；95%CI [2.75, 7.17]，P<0.00001，I²=98%），减少需要解救镇痛的患者人数（RR 0.38；95%CI [0.20, 0.74]，P=0.004，I²=75%）和需要解救镇痛的次数（SMD-2.65；95%CI [-4.23, -1.06]，P=0.001，I²=96%）。

结论

硫酸镁作为布比卡因硬膜外的佐剂可改善术后镇痛效果。然而，由于存在高度异质性、结果不精确和样本量小，我们将证据质量评为非常低。此外，仍需要进一步开展大型高质量试验来验证硫酸镁对术后镇痛的影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f04/7003447/5bbb7d992301/12871_2020_947_Fig8_HTML.jpg
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