氯胺酮与安慰剂及其他药物相比预防成人丙泊酚注射痛的疗效和安全性：一项系统评价和荟萃分析

Efficacy and Safety of Ketamine Compared with Placebo and Other Medications for Preventing Propofol Injection Pain in Adults: A Systematic Review and Meta-Analysis.

作者信息

Wu Quantong, Xu Fuchao, Wang Jie, Jiang Ming

机构信息

Department of Anesthesiology, Nanjing Drum Tower Hospital Clinical College, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.

Emergency Department, Nanjing Drum Tower Hospital Clinical College, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.

出版信息

J Pain Res. 2024 Feb 1;17:459-476. doi: 10.2147/JPR.S440250. eCollection 2024.

DOI:10.2147/JPR.S440250

PMID:38318331

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10843985/

Abstract

PURPOSE

To systematically evaluate the effectiveness and safety of ketamine in preventing propofol injection pain (PIP).

PATIENTS AND METHODS

The electronic databases including PubMed, Embase, Web of Science, and Cochrane Library were searched from their inception until 2 August 2023. Randomized controlled trials (RCT) comparing ketamine with placebo or other interventions to alleviate PIP in adults were included. Fixed-effects or random-effects models were used to calculate pooled risk ratios (RR) and corresponding 95% confidence intervals (CI) based on the heterogeneity of the studies included.

RESULTS

Thirteen RCTs involving 2105 patients were included. In terms of reducing the incidence of PIP, ketamine is more effective than placebo (RR = 0.43, 95% CI = [0.34, 0.55], < 0.00001), lidocaine (RR = 0.70, 95% CI = [0.55, 0.90], = 0.005), dexmedetomidine (RR = 0.52, 95% CI = [0.40, 0.66], < 0.00001), and thiopental (RR = 0.25, 95% CI = [0.08, 0.83], = 0.02). In reducing the incidence of severe PIP, ketamine is superior to placebo (RR = 0.12, 95% CI = [0.08, 0.19], < 0.00001), and lidocaine (RR = 0.34, 95% CI = [0.21, 0.56], < 0.0001), except dexmedetomidine (RR = 0.20, 95% CI = [0.04, 1.13], = 0.07), and thiopental (RR = 0.33, 95% CI = [0.04, 3.10], = 0.33). Compared with mixed injection, separate injection of ketamine and propofol showed no significant difference in the incidence of PIP (RR = 0.96, 95% CI = [0.31, 3.00], = 0.95) and severe PIP (RR = 1.19, 95% CI = [0.07, 21.29], = 0.90). Based solely on the reports from the studies included, subanesthetic doses of ketamine are generally safe in preventing PIP.

CONCLUSION

A subanesthetic dose of ketamine can effectively and safely reduce the incidence of PIP and severe PIP in adults, and is more effective than lidocaine, dexmedetomidine, and thiopental.

REGISTRATION

PROSPERO CRD42023455093.

摘要

目的

系统评价氯胺酮预防丙泊酚注射痛（PIP）的有效性和安全性。

患者与方法

检索电子数据库，包括PubMed、Embase、Web of Science和Cochrane图书馆，检索时间从建库至2023年8月2日。纳入比较氯胺酮与安慰剂或其他干预措施以减轻成人PIP的随机对照试验（RCT）。根据纳入研究的异质性，使用固定效应或随机效应模型计算合并风险比（RR）及相应的95%置信区间（CI）。

结果

纳入13项RCT，共2105例患者。在降低PIP发生率方面，氯胺酮比安慰剂（RR = 0.43，95%CI = [0.34, 0.55]，P < 0.00001）、利多卡因（RR = 0.70，95%CI = [0.55, 0.90]，P = 0.005）、右美托咪定（RR = 0.52，95%CI = [0.40, 0.66]，P < 0.00001）和硫喷妥钠（RR = 0.25，95%CI = [0.08, 0.83]，P = 0.02）更有效。在降低严重PIP发生率方面，氯胺酮优于安慰剂（RR = 0.12，95%CI = [0.08, 0.19]，P < 0.00001）和利多卡因（RR = 0.34，95%CI = [0.21, 0.56]，P < 0.0001），但不优于右美托咪定（RR = 0.20，95%CI = [0.04, 1.13]，P = 0.07）和硫喷妥钠（RR = 0.33，95%CI = [0.04, 3.10]，P = 0.33）。与混合注射相比，氯胺酮与丙泊酚分开注射在PIP发生率（RR = 0.96，95%CI = [0.31, 3.00]，P = 0.95）和严重PIP发生率（RR = 1.19，95%CI = [0.07, 21.29]，P = 0.90）方面无显著差异。仅根据纳入研究的报告，亚麻醉剂量的氯胺酮在预防PIP方面总体安全。