Marchand Greg J, Azadi Ali, Sainz Katelyn, Anderson Sienna, Ruther Stacy, Ware Kelly, Hopewell Sophia, Brazil Giovanna, King Alexa, Cieminski Kaitlynne, Steele Allison, Love Jennifer
Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA.
Star Urogynecology, Peoria, Arizona, USA.
Turk J Obstet Gynecol. 2021 Mar 12;18(1):56-64. doi: 10.4274/tjod.galenos.2021.06606.
To assess the efficacy of all forms of ropivacaine administration for the management of pain and opioid use, specifically in patients undergoing laparoscopic hysterectomy. We searched PubMed, Cochrane CENTRAL, Web of Science, and SCOPUS for relevant clinical trials matching our eligibility criteria. Outcomes of interest included: Pain intensity (measured either by visual analog scale score or by numerical rating scale score), QoR-40 score (Overall quality of recovery tool, designed to measure physical comfort, physical independence, pain, emotional status, and need for support), and the need for opioid rescue. We performed the analysis under the fixed-effects model for homogeneous data and random-effects model for heterogeneous data. Most heterogeneous data were solved by the leave-one-out method, in cases where this was not successful, we then proceeded to conduct at least one subgroup meta-analysis in an attempt to solve heterogeneity. We assessed the risk of bias using Cochrane's risk of bias tool. A total of five clinical trials were included. Regarding the pain score, there was no significant difference between either group [standardized mean difference=-0.17, 95% confidence interval (CI): (-0.56, 0.23); p=0.41]. The analysis of the overall RoQ40 scores favored the ropivacaine group over the control group significantly [mean difference (MD)=17.68, 95% CI: (1.48, 33.87); p<0.001]. Regarding the use of opioids, the analysis revealed no significant difference between either group [MD=-2.57, 95% CI: (-6.62, 1.49); p=0.21]. Ropivacaine administration by any method does not seem to be effective in reducing pain or reducing the need for opioid use after laparoscopic hysterectomy procedures; however, the administration did show a significant improvement in the patient's "overall quality of recovery," as measured using the QoR-40 tool.
评估所有形式的罗哌卡因给药用于疼痛管理和阿片类药物使用的疗效，特别是在接受腹腔镜子宫切除术的患者中。我们在PubMed、Cochrane CENTRAL、科学网和SCOPUS中搜索符合我们纳入标准的相关临床试验。感兴趣的结果包括：疼痛强度（通过视觉模拟量表评分或数字评分量表评分测量）、QoR-40评分（总体恢复质量工具，旨在测量身体舒适度、身体独立性、疼痛、情绪状态和支持需求）以及阿片类药物解救的需求。我们对同质数据采用固定效应模型，对异质数据采用随机效应模型进行分析。大多数异质数据通过留一法解决，若此法不成功，我们接着进行至少一项亚组Meta分析以试图解决异质性。我们使用Cochrane偏倚风险工具评估偏倚风险。共纳入五项临床试验。关于疼痛评分，两组之间无显著差异[标准化均数差=-0.17，95%置信区间（CI）：（-0.56，0.23）；p=0.41]。总体RoQ40评分分析显示罗哌卡因组显著优于对照组[均数差（MD）=17.68，95%CI：（1.48，33.87）；p<0.001]。关于阿片类药物的使用，分析显示两组之间无显著差异[MD=-2.57，95%CI：（-6.62，1.49）；p=0.21]。在腹腔镜子宫切除术后，任何方法给予罗哌卡因似乎都不能有效减轻疼痛或减少阿片类药物的使用需求；然而，使用QoR-40工具测量发现，给药确实使患者的“总体恢复质量”有显著改善。
