Abu-Zaid Ahmed, Alomar Osama, AlNaim Nora F, Abualsaud Fatimah Shakir, Jamjoom Mohammed Ziad, AlNaim Latifa F, Almubarki Abdullah Ama, Baradwan Saeed, Aboudi Saud Abdullah Saud, Idris Faisal Khalid, Fodaneel Meshael, Al-Badawi Ismail A, Salem Hany
Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Department of Obstetrics and Gynecology, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA.
Obstet Gynecol Sci. 2022 Mar;65(2):133-144. doi: 10.5468/ogs.21345. Epub 2022 Feb 23.
We aimed to perform a systematic review and meta-analysis of all randomized placebo-controlled trials (RCTs) that examined the analgesic benefits of preemptive pregabalin among patients undergoing minimally invasive hysterectomy. Five major databases were systematically screened from inception until August 29, 2021 Relevant studies were evaluated for risk of bias. Endpoints were analyzed using the random-effects model and pooled as the mean difference or risk ratio with a 95% confidence interval. Four studies with seven treatment arms met the inclusion criteria. The total sample size was 304 patients: 193 and 111 patients were allocated to the pregabalin and placebo groups, respectively. Overall, the included studies revealed a low risk of bias. The summary results revealed that the mean postoperative pain scores at rest were significantly lower in the pregabalin group than in the control group at 0, 2, 4, 6, 12, and 24 hours. Moreover, the mean postoperative pain scores on movement/coughing were significantly lower in the pregabalin group than in the control group at 12 and 24 hours. The rate of patients who were opioid-free postoperatively was significantly higher in the pregabalin group than in the control group. There was no significant difference between the groups in terms of the mean postoperative time to first rescue analgesic and the rates of adverse events. Compared with placebo, preemptive pregabalin was largely safe, and was correlated with superior analgesic effects in terms of lower postoperative pain scores and higher opioid-sparing effects. Additional RCTs are needed to confirm these findings.
我们旨在对所有随机安慰剂对照试验（RCT）进行系统评价和荟萃分析，这些试验考察了在接受微创子宫切除术的患者中，预防性使用普瑞巴林的镇痛效果。从数据库建立至2021年8月29日，我们对五个主要数据库进行了系统筛选。对相关研究进行偏倚风险评估。使用随机效应模型分析终点指标，并汇总为平均差或风险比及95%置信区间。四项研究的七个治疗组符合纳入标准。总样本量为304例患者：分别有193例和111例患者被分配至普瑞巴林组和安慰剂组。总体而言，纳入研究显示偏倚风险较低。汇总结果显示，普瑞巴林组术后静息时的平均疼痛评分在0、2、4、6、12和24小时显著低于对照组。此外，普瑞巴林组术后活动/咳嗽时的平均疼痛评分在12和24小时显著低于对照组。普瑞巴林组术后无阿片类药物使用的患者比例显著高于对照组。两组术后首次使用解救镇痛药的平均时间及不良事件发生率无显著差异。与安慰剂相比，预防性使用普瑞巴林基本安全，且在降低术后疼痛评分及提高阿片类药物节省效应方面具有更好的镇痛效果。需要更多随机对照试验来证实这些发现。
