Department of Medicine, University of New South Wales, South Wales, Australia.
Department of Anaesthesia, Royal Melbourne Hospital, Parkville, Australia; Melbourne Medical School, University of Melbourne, Parkville Australia.
J Opioid Manag. 2021 May-Jun;17(3):251-272. doi: 10.5055/jom.2021.0635.
The management of post-operative pain and high levels of acute and chronic opioid use following total knee arthroplasty (TKA) and total hip arthroplasty (THA) remain challenges to the perioperative team. We performed a system-atic review and meta-analysis to determine the opioid sparing effects, analgesic effects, and safety profile of perioperative gabapentinoid usage in lower limb arthroplasty.
We searched multiple databases from inception until May 2019 and included randomized controlled trials (RCT) on perioperative gabapentinoids in lower limb arthroplasty. The primary outcome was cumulative opioid con-sumption (oral morphine equivalents) at 24 and 48 hours, and the secondary outcomes were pain scores, time to hospi-tal discharge, and adverse events including nausea, vomiting, pruritus, and sedation. Methodological quality was as-sessed using the Cochrane tool. The grading of recommendations assessment, development, and evaluation method-ology for the certainty of evidence was also used.
We included 19 RCT involving 2,455 patients undergoing lower limb arthroplasty. The overall methodological quality of included studies was good. Gabapentinoid use was associated with a significant reduction in opioid consump-tion at 24 hour (mean difference (MD) 22.81 mg [95 percent Confidence Interval (CI) 13.64-31.98]) and 48 hour (MD 44.03 mg [95 percent CI 16.92-71.14]). We found no meaningful difference in pain scores at rest between gabapenti-noid and placebo groups at 24 or 48 hours. Gabapentinoid use reduced the risk of post-operative nausea (risk ratio (RR) 0.69 [95 percent CI 0.57-0.82]), vomiting (RR 0.65 [95 percent CI 0.47-0.91]), and pruritus (RR 0.60 [0.37-0.98]), but not sedation (RR 1.25 [0.76-2.06]). There was no effect on time to discharge from hospital (MD-0.05 days [95 per-cent CI -0.31 to 0.20].
The addition of gabapentinoids to perioperative multimodal analgesia decreases opioid consumption fol-lowing lower limb arthroplasty, while also lowering rates of nausea, vomiting, and pruritus. Further study is required to evaluate the effect of gabapentinoid use on long-term opioid use and dependence.
全膝关节置换术（TKA）和全髋关节置换术（THA）后，术后疼痛的管理和急性及慢性阿片类药物的高使用率仍然是围手术期团队面临的挑战。我们进行了系统评价和荟萃分析，以确定下肢关节置换术围手术期加巴喷丁类药物的阿片类药物节约作用、镇痛作用和安全性。
我们从开始到 2019 年 5 月搜索了多个数据库，并纳入了下肢关节置换术围手术期加巴喷丁类药物的随机对照试验（RCT）。主要结局是 24 小时和 48 小时时累积阿片类药物的消耗（口服吗啡等效物），次要结局是疼痛评分、出院时间以及包括恶心、呕吐、瘙痒和镇静在内的不良事件。使用 Cochrane 工具评估方法学质量。还使用推荐评估、制定和评估方法学（GRADE）评估证据确定性的等级。
我们纳入了 19 项涉及 2455 例接受下肢关节置换术的 RCT。纳入研究的整体方法学质量良好。加巴喷丁类药物的使用与阿片类药物消耗的显著减少相关，在 24 小时时（平均差异（MD）22.81mg[95%置信区间（CI）13.64-31.98]）和 48 小时时（MD 44.03mg[95%CI 16.92-71.14]）。我们发现，在 24 小时或 48 小时时，加巴喷丁组和安慰剂组在静息时的疼痛评分之间没有显著差异。加巴喷丁类药物的使用降低了术后恶心（风险比（RR）0.69[95%CI 0.57-0.82]）、呕吐（RR 0.65[95%CI 0.47-0.91]）和瘙痒（RR 0.60[0.37-0.98]）的风险，但不降低镇静（RR 1.25[0.76-2.06]）的风险。对出院时间（MD-0.05 天[95%CI-0.31 至 0.20]）没有影响。
在下肢关节置换术围手术期多模式镇痛中加入加巴喷丁类药物可减少阿片类药物的消耗，同时降低恶心、呕吐和瘙痒的发生率。需要进一步研究来评估加巴喷丁类药物使用对长期阿片类药物使用和依赖的影响。
