加巴喷丁类药物在术后急性疼痛管理中的围手术期应用：系统评价和荟萃分析。
Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain: A Systematic Review and Meta-analysis.
机构信息
From the Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec - Université Laval Research Center, Québec City, Québec, Canada (M.V., F.L., C.P., X.S., A.-M.P., G.L., M.-J.C., X.N., A.F.T.) the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine (M.V., F.L., A.-M.P., G.L., A.F.T.) the Department of Medicine (F.L.) Faculty of Medicine, and the Interdisciplinary Research Centre for Rehabilitation and Social Integration (A.-M.P.), Université Laval, Québec City, Québec, Canada the Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, Manitoba, Canada (R.Z.) the Department of Haematology and Medical Oncology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada (R.Z.).
出版信息
Anesthesiology. 2020 Aug;133(2):265-279. doi: 10.1097/ALN.0000000000003428.
BACKGROUND
Widely used for acute pain management, the clinical benefit from perioperative use of gabapentinoids is uncertain. The aim of this systematic review was to assess the analgesic effect and adverse events with the perioperative use of gabapentinoids in adult patients.
METHODS
Randomized controlled trials studying the use of gabapentinoids in adult patients undergoing surgery were included. The primary outcome was the intensity of postoperative acute pain. Secondary outcomes included the intensity of postoperative subacute pain, incidence of postoperative chronic pain, cumulative opioid use, persistent opioid use, lengths of stay, and adverse events. The clinical significance of the summary estimates was assessed based on established thresholds for minimally important differences.
RESULTS
In total, 281 trials (N = 24,682 participants) were included in this meta-analysis. Compared with controls, gabapentinoids were associated with a lower postoperative pain intensity (100-point scale) at 6 h (mean difference, -10; 95% CI, -12 to -9), 12 h (mean difference, -9; 95% CI, -10 to -7), 24 h (mean difference, -7; 95% CI, -8 to -6), and 48 h (mean difference, -3; 95% CI, -5 to -1). This effect was not clinically significant ranging below the minimally important difference (10 points out of 100) for each time point. These results were consistent regardless of the type of drug (gabapentin or pregabalin). No effect was observed on pain intensity at 72 h, subacute and chronic pain. The use of gabapentinoids was associated with a lower risk of postoperative nausea and vomiting but with more dizziness and visual disturbance.
CONCLUSIONS
No clinically significant analgesic effect for the perioperative use of gabapentinoids was observed. There was also no effect on the prevention of postoperative chronic pain and a greater risk of adverse events. These results do not support the routine use of pregabalin or gabapentin for the management of postoperative pain in adult patients.
背景
加巴喷丁类药物被广泛用于急性疼痛管理，但围手术期使用的临床获益尚不确定。本系统评价旨在评估成年患者围手术期使用加巴喷丁类药物的镇痛效果和不良反应。
方法
纳入研究成年患者接受手术时使用加巴喷丁类药物的随机对照试验。主要结局是术后急性疼痛的强度。次要结局包括术后亚急性疼痛的强度、术后慢性疼痛的发生率、累积阿片类药物使用量、持续阿片类药物使用量、住院时间和不良反应。根据最小临床重要差异的既定标准，评估汇总估计值的临床意义。
结果
共有 281 项试验（N=24682 名参与者）纳入本荟萃分析。与对照组相比，加巴喷丁类药物可降低术后 6 小时（100 分制）（平均差值，-10；95%CI，-12 至-9）、12 小时（平均差值，-9；95%CI，-10 至-7）、24 小时（平均差值，-7；95%CI，-8 至-6）和 48 小时（平均差值，-3；95%CI，-5 至-1）的疼痛强度。每个时间点的差异均未达到最小临床重要差异（100 分制 10 分），因此这种效果无临床意义。这些结果与药物类型（加巴喷丁或普瑞巴林）无关。在 72 小时、亚急性和慢性疼痛时，未观察到疼痛强度的影响。加巴喷丁类药物的使用与术后恶心和呕吐的风险降低相关，但与头晕和视觉障碍的风险增加相关。
结论
未观察到围手术期使用加巴喷丁类药物有明显的镇痛效果。对预防术后慢性疼痛也没有影响，且不良反应风险增加。这些结果不支持常规使用普瑞巴林或加巴喷丁来管理成年患者的术后疼痛。
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