静脉注射利多卡因在减肥手术后镇痛的疗效：一项随机对照研究的荟萃分析。
Efficacy of intraoperative intravenous lidocaine for postoperative analgesia following bariatric surgery: a meta-analysis of randomized controlled studies.
机构信息
Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan; General Education Center, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan.
Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan; Department of Recreation and Health-Care Management, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan city, Taiwan.
出版信息
Surg Obes Relat Dis. 2022 Jan;18(1):135-147. doi: 10.1016/j.soard.2021.08.014. Epub 2021 Sep 1.
BACKGROUND
The impact of intravenous lidocaine in adults undergoing laparoscopic bariatric surgeries (LBS) remains unclear.
OBJECTIVES
This study aimed at investigating the effect of intravenous lidocaine on postoperative opioid consumption and recovery following LBS.
SETTING
Meta-analysis.
METHODS
We searched databases including MEDLINE, Embase, Google Scholar, and the Cochrane Library for randomized controlled trials that evaluated the use of intravenous lidocaine compared to placebo only prior to May 2021. The primary outcome was 24-hour postoperative opioid consumption, while secondary outcomes included pain score, quality of recovery (QOR)-40 score, length of hospital stay (LOS), and postoperative nausea/vomiting (PONV).
RESULTS
Seven trials (496 participants) were included. Intraoperative intravenous lidocaine significantly reduced 24-hour equivalent morphine consumption (mean difference [MD]: -11.97 mg; 95% confidence interval [CI]: -23.12 to -.83), pain score at 1 to 3 hours (MD: -.77; 95% CI: -1.5 to -.04), and LOS (MD: -8.93 hr; 95% CI: -13.41 to -4.44) without positive impact on 24-hour pain score and PONV. There was also an increase in time to first opioid requirement (MD: 20.23 min; 95% CI: 11.76-28.7) and QOR-40 score (MD: 24.38; 95% CI: 5.57-43.18). However, sensitivity analysis demonstrated evidence supporting the beneficial effect of lidocaine only for time to first opioid requirement and QOR-40. The associations of intraoperative intravenous lidocaine with reductions in morphine consumption, pain score at 1 to 3 hours, and LOS after LBS were also weak.
CONCLUSION
Intraoperative intravenous lidocaine during LBS prolonged time to first opioid requirement and improved quality of recovery postoperatively without 24-hour pain or nausea/vomiting benefits. Due to the small number of trials, larger studies are warranted to verify our findings.
背景
静脉注射利多卡因对行腹腔镜减重手术（LBS）的成年人的影响尚不清楚。
目的
本研究旨在探讨静脉注射利多卡因对 LBS 术后阿片类药物消耗和恢复的影响。
设置
荟萃分析。
方法
我们检索了包括 MEDLINE、Embase、Google Scholar 和 Cochrane 图书馆在内的数据库，以寻找评估与安慰剂相比在术前使用静脉注射利多卡因的随机对照试验，检索时间截至 2021 年 5 月。主要结局为 24 小时术后阿片类药物消耗量，次要结局包括疼痛评分、恢复质量（QOR）-40 评分、住院时间（LOS）和术后恶心/呕吐（PONV）。
结果
纳入 7 项试验（496 名参与者）。术中静脉注射利多卡因可显著减少 24 小时等效吗啡消耗量（平均差[MD]：-11.97mg；95%置信区间[CI]：-23.12 至 -.83）、1 至 3 小时疼痛评分（MD：-.77；95%CI：-1.5 至 -.04）和 LOS（MD：-8.93 小时；95%CI：-13.41 至 -4.44），但对 24 小时疼痛评分和 PONV 无积极影响。首次使用阿片类药物的时间也有所延长（MD：20.23 分钟；95%CI：11.76-28.7），QOR-40 评分升高（MD：24.38；95%CI：5.57-43.18）。然而，敏感性分析表明，利多卡因对首次使用阿片类药物的时间和 QOR-40 有有益的影响。利多卡因与 LBS 后吗啡消耗减少、1 至 3 小时疼痛评分和 LOS 降低之间的关联也较弱。
结论
LBS 术中静脉注射利多卡因可延长首次使用阿片类药物的时间，并改善术后恢复质量，而不会改善 24 小时疼痛或恶心/呕吐。由于试验数量较少，需要更大规模的研究来验证我们的发现。
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