在开腹子宫切除术中外用加巴喷丁是否有效和安全？一项符合 PRISMA 标准的随机对照试验荟萃分析。
Is gabapentin effective and safe in open hysterectomy? A PRISMA compliant meta-analysis of randomized controlled trials.
机构信息
Department of Anesthesiology, Tianjin First Center Hospital, No.24 Fukang Road, Nankai District, Tianjin City 300192, PR China.
Department of Orthopedics, Tianjin Hospital, No. 406 Jiefang South Road, Hexi District, Tianjin City 300211, PR China.
出版信息
J Clin Anesth. 2017 Sep;41:76-83. doi: 10.1016/j.jclinane.2017.07.002. Epub 2017 Jul 18.
BACKGROUND
Pain management after open hysterectomy has been investigated for years. Owing to the effect of significant analgesic, gabapentin was often administrated for pre-emptive analgesia. However, the relationship between gabapentin and postoperative pain after open hysterectomy is still controversial. This meta-analysis was applied to assess the efficacy of pre-emptive use of gabapentin in open hysterectomy.
METHODS
This meta-analysis of randomized controlled trials (RCTs) was performed to compare the use of gabapentin with placebo in open hysterectomy regarding (1) the mean difference (MD) of postoperative opioid requirements; (2) the changes of visual analogue scale (VAS) scores in two groups; and (3) incidence rate of adverse effects. Systematic searches of all related literatures was conducted using the following databases: MEDLINE, EMBASE, ClinicalTrials.gov and Web of Science. Only randomized controlled trials (RCTs) for open hysterectomy were included. The MD of postoperative opioid requirements and VAS scores, relative risk (RR) of incidence rate of adverse effects in the gabapentin group versus placebo group were extracted throughout the study.
RESULTS
Fourteen trials were included in this meta-analysis. The total opioid consumption at 24h was a less in gabapentin group. (MD=-11.61, 95% CI: -16.71 to -6.51, P=0.00) The visual analogue scale (VAS) score at 4, 12 and 24h were less in the gabapentin group. (MD=-16.83, 95% CI: -22.88 to -10.77, P=0.00), (MD=-17.45, 95% CI: -21.83 to -13.08, P=0.00), (MD=-9.83, 95% CI: -13.31 to -6.35, P=0.00) The incidence rate of vomiting and nausea were significantly less in gabapentin groups. (RR 0.13, 95% CI 0.45 to 0.73, P=0.00), (RR 0.67, 95% CI 0.49 to 0.93, P=0.02). Compared with placebo, gabapentin achieved higher patient satisfaction. (MD=20.43, 95% CI: 12.42 to 28.44, P<0.00).
CONCLUSION
This meta-analysis suggested that the employment of gabapentin was efficacious in reduction of postoperative opioid consumption, VAS score and some side effects after open hysterectomy.
背景
开腹子宫切除术的疼痛管理已研究多年。由于具有显著的镇痛作用，加巴喷丁常被用于预防性镇痛。然而，加巴喷丁与开腹子宫切除术后疼痛的关系仍存在争议。本荟萃分析旨在评估开腹子宫切除术前使用加巴喷丁的疗效。
方法
本荟萃分析纳入了随机对照试验（RCT），比较了开腹子宫切除术前使用加巴喷丁与安慰剂的效果：（1）术后阿片类药物需求量的均数差（MD）；（2）两组视觉模拟量表（VAS）评分的变化；（3）不良反应发生率。使用以下数据库系统地检索了所有相关文献：MEDLINE、EMBASE、ClinicalTrials.gov 和 Web of Science。仅纳入了开腹子宫切除术的 RCT。在研究中提取了术后阿片类药物需求量 MD 和 VAS 评分，加巴喷丁组与安慰剂组不良反应发生率的相对风险（RR）。
结果
本荟萃分析纳入了 14 项试验。加巴喷丁组 24 小时内的总阿片类药物消耗量较少。（MD=-11.61，95%CI：-16.71 至-6.51，P=0.00）加巴喷丁组 4、12 和 24 小时的视觉模拟量表（VAS）评分较低。（MD=-16.83，95%CI：-22.88 至-10.77，P=0.00），（MD=-17.45，95%CI：-21.83 至-13.08，P=0.00），（MD=-9.83，95%CI：-13.31 至-6.35，P=0.00）加巴喷丁组呕吐和恶心的发生率显著较低。（RR 0.13，95%CI 0.45 至 0.73，P=0.00），（RR 0.67，95%CI 0.49 至 0.93，P=0.02）。与安慰剂相比，加巴喷丁可提高患者满意度。（MD=20.43，95%CI：12.42 至 28.44，P<0.00）。
结论
本荟萃分析表明，开腹子宫切除术前使用加巴喷丁可有效减少术后阿片类药物的消耗、VAS 评分和一些不良反应。
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