Ge Zhuoqi, Li Mingnian, Chen Yu, Sun Yufeng, Zhang Rui, Zhang Jiaxing, Bai Xue, Zhang Yanyan, Chen Qi
Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, 550002, China.
College of Pharmacy, Guizhou Medical University, Guiyang, 550025, China.
Pain Ther. 2023 Aug;12(4):1065-1078. doi: 10.1007/s40122-023-00500-6. Epub 2023 Jun 7.
Postoperative pain after artificial joint replacement is intense and remains an unsolved problem. Some studies have shown that parecoxib can provide better analgesia in postoperative multimodal analgesia, however, doubts arise about whether its multimodal preemptive analgesia can reduce postoperative pain.
The purpose of this systematic review and meta-analysis was to evaluate the impact of preoperative injection of parecoxib on postoperative pain in patients undergoing artificial joint replacement.
Systematic review and meta-analysis.
Embase, PubMed, Cochrane Library, CNKI, VIP, Wangfang databases were searched to identify relevant randomized controlled trials. The last search was in May 2022.
Randomized controlled trials of efficacy and adverse reactions of intra-operative and postoperative injection of parecoxib in artificial joint replacement were collected. The primary outcome was postoperative visual analog scale scores and the secondary outcomes included cumulative postoperative opioid consumption and incidence of adverse reactions. Using the Cochrane systematic review method to screen the studies, evaluate the quality of the included studies, and extract feature information, RevMan 5.4 software performs a meta-analysis of the corresponding research indicators.
In total, nine studies were involved in the meta-analysis with 667 patients. The trial and control group were given the same dose of parecoxib or placebo at the same time point before and after surgery. The results showed that compared with the control group, the trial group is associated with substantially reduced visual analog scale scores in 24, 48 h at rest (P < 0.05), visual analog scale scores in 24, 48, 72 h at movement (P < 0.05), dose of opioid need in trial group is notably lower than that in control group (P < 0.05), but shows no obvious effect on visual analog scale scores in 72 h at rest, and adverse events (P > 0.05).
The major limitation of this meta-analysis relates to some low-quality studies.
Our results support parecoxib multimodal preemptive analgesia in reducing postoperative acute pain in hip and knee replacement patients, and reduces cumulative opioid consumption without increasing the risk of adverse drug events. Its multimodal preemptive analgesia is safe and effective in hip and knee replacement.
CRD42022379672.
人工关节置换术后疼痛剧烈，仍是一个尚未解决的问题。一些研究表明，帕瑞昔布在术后多模式镇痛中能提供更好的镇痛效果，然而，对于其多模式超前镇痛是否能减轻术后疼痛存在疑问。
本系统评价和荟萃分析的目的是评估术前注射帕瑞昔布对人工关节置换患者术后疼痛的影响。
系统评价和荟萃分析。
检索Embase、PubMed、Cochrane图书馆、中国知网、维普、万方数据库以识别相关随机对照试验。最后一次检索时间为2022年5月。
收集帕瑞昔布在人工关节置换术中及术后注射的疗效和不良反应的随机对照试验。主要结局是术后视觉模拟评分，次要结局包括术后阿片类药物累计消耗量和不良反应发生率。采用Cochrane系统评价方法筛选研究、评估纳入研究的质量并提取特征信息，RevMan 5.4软件对相应研究指标进行荟萃分析。
荟萃分析共纳入9项研究，667例患者。试验组和对照组在手术前后的相同时间点给予相同剂量的帕瑞昔布或安慰剂。结果显示，与对照组相比，试验组在静息24、48小时时视觉模拟评分显著降低（P<0.05），活动24、48、72小时时视觉模拟评分显著降低（P<0.05），试验组阿片类药物需求量明显低于对照组（P<0.05），但对静息72小时时视觉模拟评分及不良事件无明显影响（P>0.05）。
本荟萃分析的主要局限性与一些低质量研究有关。
我们的结果支持帕瑞昔布多模式超前镇痛可减轻髋膝关节置换患者术后急性疼痛，并减少阿片类药物累计消耗量，且不增加药物不良事件风险。其多模式超前镇痛在髋膝关节置换中安全有效。
PROSPERO注册编号：CRD42022379672。
