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INTRODUCTION

The purpose of this systematic review and network meta-analysis was to evaluate the efficacy and safety of different preemptive analgesia measures given before laparoscopic cholecystectomy (LC) for postoperative pain in patients.

METHODS

We conducted a comprehensive search in databases including PubMed, Web of Science, Embase, and the Cochrane Library up to March 2024, and collected relevant research data on the 26 preemptive analgesia measures defined in this article in LC surgery. Outcomes included postoperative Visual Analogue Scores (VAS) at different times (2, 6, 12, and 24 h), opioid consumption within 24 h post-operation, time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV), and incidence of postoperative headache or dizziness.

RESULTS

Forty-nine articles involving 5987 patients were included. The network meta-analysis revealed that multimodal analgesia, nerve blocks, pregabalin, and gabapentin significantly reduced postoperative pain scores at all postoperative time points and postoperative opioid consumption compared to placebo. Tramadol, pregabalin, and gabapentin significantly extended the time to first rescue analgesia. Ibuprofen was the best intervention for reducing PONV incidence. Tramadol significantly reduced the incidence of postoperative headache or dizziness. Subgroup analysis of different doses of pregabalin and gabapentin showed that compared to placebo, pregabalin (300 mg, 150 mg) and gabapentin (600 mg, 300 mg, and 20 mg/kg) were all more effective without significant differences in efficacy between these doses. Higher doses increased the incidence of PONV and postoperative headache and dizziness, with gabapentin 300 mg having a lower adverse drug reaction (ADR) incidence.

CONCLUSIONS

Preemptive analgesia significantly reduced postoperative pain intensity, opioid consumption, extended the time to first rescue analgesia, and decreased the incidence of PONV and postoperative headache and dizziness. Multimodal analgesia, nerve blocks, pregabalin, and gabapentin all showed good efficacy. Gabapentin 300 mg given preoperatively significantly reduced postoperative pain and ADR incidence, recommended for preemptive analgesia in LC.

TRIAL REGISTRATION

PROSPERO CRD42024522185.

INTRODUCTION

METHODS

RESULTS

CONCLUSIONS

TRIAL REGISTRATION

PROSPERO CRD42024522185.

引言

本系统评价和网状Meta分析的目的是评估腹腔镜胆囊切除术（LC）前给予不同的超前镇痛措施对患者术后疼痛的疗效和安全性。

方法

截至2024年3月，我们在包括PubMed、Web of Science、Embase和Cochrane图书馆在内的数据库中进行了全面检索，并收集了本文定义的26种LC手术超前镇痛措施的相关研究数据。结局指标包括术后不同时间（2、6、12和24小时）的视觉模拟评分（VAS）、术后24小时内的阿片类药物消耗量、首次补救镇痛时间、术后恶心呕吐（PONV）发生率以及术后头痛或头晕发生率。

结果

纳入49篇文章，涉及5987例患者。网状Meta分析显示，与安慰剂相比，多模式镇痛、神经阻滞、普瑞巴林和加巴喷丁在所有术后时间点均显著降低术后疼痛评分和术后阿片类药物消耗量。曲马多、普瑞巴林和加巴喷丁显著延长首次补救镇痛时间。布洛芬是降低PONV发生率的最佳干预措施。曲马多显著降低术后头痛或头晕发生率。不同剂量普瑞巴林和加巴喷丁的亚组分析显示，与安慰剂相比，普瑞巴林（300mg、150mg）和加巴喷丁（600mg、300mg和20mg/kg）均更有效，且这些剂量之间疗效无显著差异。较高剂量增加PONV以及术后头痛和头晕的发生率，加巴喷丁300mg的药物不良反应（ADR）发生率较低。