静脉输注利多卡因促进结直肠癌大手术后肠功能恢复：通过更新的荟萃分析、试验序贯分析、证据确定性和Meta回归进行的批判性评价

Intravenous Infusion of Lidocaine for Bowel Function Recovery After Major Colorectal Surgery: A Critical Appraisal Through Updated Meta-Analysis, Trial Sequential Analysis, Certainty of Evidence, and Meta-Regression.

作者信息

Chen Po-Chuan, Lai Chao-Han, Fang Ching-Ju, Lai Pei Chun, Huang Yen Ta

机构信息

Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

出版信息

Front Med (Lausanne). 2022 Jan 27;8:759215. doi: 10.3389/fmed.2021.759215. eCollection 2021.

DOI:10.3389/fmed.2021.759215

PMID:35155463

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8828648/

Abstract

BACKGROUND

Intravenous infusion of lidocaine (IVF-Lido) during the perioperative period is an option to accelerate bowel function recovery after major colorectal surgery. However, previous meta-analyses have shown inconsistent conclusions. Recent randomized controlled trials (RCTs) have been reported after the publication of a previous meta-analysis.

AIM

We conducted an updated and comprehensive meta-analysis to determine the effects of IVF-Lido on time to first flatus and defecation after major colorectal surgery.

METHODS

We performed a systematic review according to the Preferred Reporting Items for the Systematic Reviews and Meta-Analysis Protocols 2020 guideline. Only RCTs were included. The revised Cochrane risk-of-bias tool was chosen for appraisal. Meta-analysis with meta-regression and trial sequential analysis was carried out. The Doi plot was presented to evaluate publication bias. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology was executed to evaluate the certainty of evidence (CoE).

RESULTS

Thirteen RCTs with 696 participants were enrolled. IVF-Lido significantly decreased the time to first flatus [mean difference (MD) = -6.03 h; 95% confidence interval (CI): (-8.80, -3.26)] and first defecation [MD = -10.49 h; 95% CI: (-15.58, -5.41)]. Trial sequential analysis yielded identical results and ampleness of required information sizes. No obviousness in publication bias was detected, and the CoE in GRADE was low in both outcomes. Meta-regression showed that a significantly shorter time to the first defecation was associated with studies with more improvement in pain control in comparison of two groups and better-improved analgesia in the control group.

CONCLUSIONS

We discretionarily suggest the use of IVF-Lido on postoperative bowel function recovery following major colorectal surgery. Beyond the analgesic effects, IVF-Lido might have additional benefits when postoperative pain relief has already been achieved. Considering the high heterogeneity in this updated meta-analysis, more RCTs are needed.

SYSTEMATIC REVIEW REGISTRATION

https://inplasy.com/inplasy-2020-7-0023/, INPLASY [202070023].

摘要

背景

围手术期静脉输注利多卡因（IVF-Lido）是加速大肠大手术后肠功能恢复的一种选择。然而，先前的荟萃分析得出了不一致的结论。在之前的荟萃分析发表后，近期有随机对照试验（RCT）报告。

目的

我们进行了一项更新的综合荟萃分析，以确定IVF-Lido对大肠大手术后首次排气和排便时间的影响。

方法

我们根据《系统评价和荟萃分析方案的首选报告项目2020》指南进行了系统评价。仅纳入RCT。选择修订后的Cochrane偏倚风险工具进行评估。进行了荟萃回归和试验序贯分析的荟萃分析。绘制漏斗图以评估发表偏倚。采用推荐分级、评估、制定和评价（GRADE）方法评估证据确定性（CoE）。

结果

纳入了13项RCT，共696名参与者。IVF-Lido显著缩短了首次排气时间[平均差（MD）=-6.03小时；95%置信区间（CI）：（-8.80，-3.26）]和首次排便时间[MD=-10.49小时；95%CI：（-15.58，-5.41）]。试验序贯分析得出了相同的结果以及所需信息量的充足性。未检测到明显的发表偏倚，两个结局的GRADE证据确定性均较低。荟萃回归显示，与两组疼痛控制改善更多且对照组镇痛改善更好的研究相比，首次排便时间显著缩短。