Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America.
Zucker School of Medicine at Hofstra/Northwell, Department of Anesthesiology, Northwell Health, New Hyde Park, NY, United States of America.
J Clin Anesth. 2021 Oct;73:110331. doi: 10.1016/j.jclinane.2021.110331. Epub 2021 May 5.
To identify whether adding intrathecal ketamine to intrathecal bupivacaine prolongs the time to first analgesic request in adult humans.
A meta-analysis of randomized controlled trials in humans.
The majority of data was obtained in an operating room and postoperative recovery area.
A total of 750 ASA physical status I and II patients were included in the study. Procedures performed include: cesarean section, lower abdominal surgery, lower limb surgery, and urologic surgery.
Databases including PubMed, Embase, Web of Science, and Cochrane were searched. Google Scholar was also queried. Multiple reviewers screened the papers for inclusion.
The primary outcome assessed was time to first analgesic request. Secondary outcomes included onset of sensory blockade, onset of motor blockade, duration of sensory blockade, and duration of motor blockade. Data were extracted to include means, 95% confidence intervals, tests for heterogeneity, and use of the Cochrane Collaboration guidelines to assess for publication bias.
Eleven randomized controlled trials met inclusion criteria. When comparing intrathecal bupivacaine plus ketamine to intrathecal bupivacaine alone, the time to first analgesic request was prolonged (effect size = 58.23 min (95% CI 37.36 to 79.10) p < 0.0001). Secondary outcomes showed the onset time of sensory blockade was shortened (effect size = -0.87 min (95% CI -1.361 to 0.378) p = 0.0005), the onset time of motor blockade was reduced (effect size = -0.88 min (95% CI -1.77 to 0.013) p = 0.05), the duration of sensory blockade was prolonged (effect size = 39.73 min (95% CI 15.97 to 63.50) p = 0.001), and the duration of motor blockade was prolonged (effect size = 4.02 min (95% CI 3.27 to 4.78) p < 0.0001). Studies were shown to have high heterogeneity. Egger tests for all outcomes were non-significant and funnel plots assessing publication bias were all asymmetrical.
The studies analyzed suggest there may be a benefit to using intrathecal ketamine as an adjunct to bupivacaine. Additional studies are warranted to optimize dosing, clarify the safety and efficacy of this intrathecal drug combination, and examine the various ketamine formulations as intrathecal bupivacaine adjuvants.
确定鞘内给予氯胺酮是否会延长鞘内布比卡因给药后首次镇痛需求的时间。
在人类中进行的随机对照试验的荟萃分析。
大部分数据来自手术室和术后恢复区。
共纳入 750 名 ASA 身体状况 I 和 II 级的患者。进行的手术包括剖宫产术、下腹部手术、下肢手术和泌尿科手术。
检索了 PubMed、Embase、Web of Science 和 Cochrane 数据库。还查询了 Google Scholar。多名评审员筛选了纳入的论文。
主要评估指标为首次镇痛需求的时间。次要结果包括感觉阻滞的起始时间、运动阻滞的起始时间、感觉阻滞的持续时间和运动阻滞的持续时间。提取数据包括平均值、95%置信区间、异质性检验和使用 Cochrane 协作组指南评估发表偏倚。
11 项随机对照试验符合纳入标准。与鞘内布比卡因加氯胺酮相比，鞘内布比卡因单独使用时首次镇痛需求的时间延长（效应量=58.23 分钟（95%CI 37.36 至 79.10），p<0.0001）。次要结果显示感觉阻滞的起始时间缩短（效应量=-0.87 分钟（95%CI -1.361 至 0.378），p=0.0005），运动阻滞的起始时间缩短（效应量=-0.88 分钟（95%CI -1.77 至 0.013），p=0.05），感觉阻滞的持续时间延长（效应量=39.73 分钟（95%CI 15.97 至 63.50），p=0.001），运动阻滞的持续时间延长（效应量=4.02 分钟（95%CI 3.27 至 4.78），p<0.0001）。研究显示存在高度异质性。所有结局的 Egger 检验均无统计学意义，评估发表偏倚的漏斗图均不对称。
分析的研究表明，鞘内给予氯胺酮作为布比卡因的辅助药物可能有益。需要进一步的研究来优化剂量，阐明这种鞘内药物组合的安全性和有效性，并研究不同的氯胺酮制剂作为鞘内布比卡因的辅助药物。
