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选择性环氧化酶-2 抑制剂的超前镇痛可减轻全膝关节置换术后患者的术后疼痛：PRISMA 指导的随机对照试验荟萃分析方案。

Preemptive analgesia using selective cyclooxygenase-2 inhibitors alleviates postoperative pain in patients undergoing total knee arthroplasty: A protocol for PRISMA guided meta-analysis of randomized controlled trials.

机构信息

Department of the Second Joint Surgery, Weifang People's Hospital.

Department of Clinical Medicine, Weifang Medical College, Weifang.

出版信息

Medicine (Baltimore). 2021 Feb 19;100(7):e24512. doi: 10.1097/MD.0000000000024512.

DOI:10.1097/MD.0000000000024512
PMID:33607780
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7899831/
Abstract

BACKGROUND

The postoperative pain associated with total knee arthroplasty (TKA) is severe for most patients. The analgesic efficacy and safety of preoperative use of selective cyclooxygenase-2 (COX-2) inhibitors for patients undergoing TKA are unclear.

OBJECTIVES

We conducted a systematic review and meta-analysis to assess whether the use of selective COX-2 inhibitors before TKA decreases the postoperative pain intensity.

METHODS

Data sources: The PubMed, Embase, EBSCO, Web of Science, and Cochrane Controlled Register of Trials databases from inception to January 2020.

STUDY ELIGIBILITY CRITERIA

All randomized controlled trials (RCTs) in which the intervention treatment was preoperative selective COX-2 vs placebo in patients undergoing TKA and that had at least one of the quantitative outcomes mentioned in the following section of this paper were included. Letters, review articles, case reports, editorials, animal experimental studies, and retrospective studies were excluded.

INTERVENTIONS

All RCTs in which the intervention treatment was preoperative selective COX-2 vs placebo in patients undergoing TKA.

STUDY APPRAISAL AND SYNTHESIS METHODS

The quality of the RCTs was quantified using the Newcastle-Ottawa quality assessment scale. RevMan 5.3 software was used for the meta-analysis.

RESULTS

Six RCTs that had enrolled a total of 574 patients were included in the meta-analysis. The visual analog scale pain score at rest was significantly different between the experimental group and control group at 24 hours (P < .05) and 72 hours (P < .05) postoperatively. The experimental group exhibited a significant visual analog scale pain score during flexion at 24 hours postoperatively (P < .05), and it was not different at 72 hours postoperatively (P = .08). There was a significant difference in opioid consumption (P < .05), but there was no difference in the operation time (P = .24) or postoperative nausea/vomiting (P = .64) between the groups.

CONCLUSION

The efficacy of preoperative administration of selective COX-2 inhibitors to reduce postoperative pain and opioid consumption after TKA is validated.

SYSTEMATIC REVIEW REGISTRATION NUMBER

INPLASY202090101.

摘要

背景

全膝关节置换术（TKA）后疼痛剧烈，大多数患者均如此。对于接受 TKA 的患者，术前使用选择性环氧化酶-2（COX-2）抑制剂的镇痛效果和安全性尚不清楚。

目的

我们进行了一项系统评价和荟萃分析，以评估 TKA 术前使用选择性 COX-2 抑制剂是否能降低术后疼痛强度。

方法

数据来源：从建库至 2020 年 1 月，检索 PubMed、Embase、EBSCO、Web of Science 和 Cochrane 对照试验注册库。

研究入选标准

所有干预措施为 TKA 术前选择性 COX-2 与安慰剂比较的随机对照试验（RCT），且至少有以下部分中提到的定量结局之一。排除信件、综述文章、病例报告、社论、动物实验研究和回顾性研究。

干预措施

所有 TKA 术前选择性 COX-2 与安慰剂比较的 RCT。

研究评估和综合方法

采用纽卡斯尔-渥太华质量评估量表对 RCT 质量进行量化。使用 RevMan 5.3 软件进行荟萃分析。

结果

共纳入 6 项 RCT，总计 574 例患者。术后 24 小时（P<0.05）和 72 小时（P<0.05）时，实验组与对照组静息时视觉模拟评分疼痛明显不同。术后 24 小时时，实验组在膝关节弯曲时的视觉模拟评分疼痛明显（P<0.05），但在术后 72 小时时无差异（P=0.08）。两组间阿片类药物用量（P<0.05）差异显著，但手术时间（P=0.24）或术后恶心/呕吐（P=0.64）无差异。

结论

术前使用选择性 COX-2 抑制剂可有效减轻 TKA 后疼痛和阿片类药物的使用。

系统评价注册号

INPLASY202090101。

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