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| 右美托咪定联合局麻药腹腔滴注缓解腹腔镜手术术后疼痛的Meta分析 |
| Intraperitoneal instillation of dexmedetomidine plus local anesthetic relieves the postoperative pain in laparoscopic surgery: a meta-analysis |
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| DOI：10.12089/jca.2020.04.012 |
| 中文关键词: 右美托咪定 腹腔镜 术后疼痛 Meta分析 |
| 英文关键词: Dexmedetomidine Laparoscopy Postoperative pain Meta-analysis |
| 基金项目:国家自然科学基金（81771206，81974172） |
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| 中文摘要: |
目的 采用Meta分析的方法评价右美托咪定联合局麻药腹腔滴注用于腹腔镜手术术后镇痛的有效性和安全性。
方法 检索Cochrane、Embase、Web of Science、Pubmed、CBM、知网、万方和维普等数据库，纳入比较右美托咪定联合局麻药（研究组）与单独局麻药（对照组）腹腔滴注的随机对照试验（RCT）。两名研究者独立进行文献筛选、质量评价、数据提取后，分别用RevMan 5.3和TSAv0.9Beta进行Meta分析和试验序贯分析（TSA）。
结果 共纳入5项RCT研究，共320例患者。与对照组比较，研究组术后24 h内各时点VAS疼痛评分明显降低（P<0.05），术后镇痛时间明显延长（P=0.002），镇痛药使用量明显减少（P<0.001），术后肩痛发生率明显降低（P<0.001），术后呕吐的发生率明显降低（P<0.05）。两组术后恶心、低血压和心动过缓的发生率差异无统计学意义。
结论 在腹腔镜手术中右美托咪定作为局麻药的佐剂腹腔滴注增强局麻药的作用效果，但鉴于该给药途径超说明书使用，腹腔内使用时应谨慎。 |
| 英文摘要: |
Objective To evaluate the analgesic efficacy and safety of intraperitoneal instillation of local anesthetic plus dexmedetomidine in patients following laparoscopic surgery.
Methods The database of Pubmed, Embase, Web of Science, Cochrane library, CBM, CNKI, WanFang data, VIP were systematically searched, and the randomized controlled trials comparing intraperitoneal instillation of local anesthetic plus dexmedetomidine with local anesthetic alone in laparoscopic surgery were included. Two reviewers independently conducted literature selection, quality assessment, data extraction. Meta-analyses and trial sequential analyses were carried out using RevMan 5.3 software and TSAv0.9Beta respectively.
Results A total of 5 studies were included. Compared with the local anesthetic alone group, the visual analogue scale scores within 24 h after surgery were lower (P < 0.05), the analgesic duration was prolonged (P = 0.002), the cumulative rescue analgesia consumption was reduced (P < 0.001), the incidence of shoulder pain was reduced (P < 0.001) within 24 hours after operation in the dexmedetomidine plus local anesthetic group. Intraperitoneal instillation of local anesthetic together with dexmedetomidine reduced the incidence of vomiting within 24 hours after surgery and there were no significant differences in the incidence rate of nausea, hypotension and bradycardia between the two groups.
Conclusion Intraperitoneal instillation of dexmedetomidine together with local anesthetic enhance the effect of local anesthetic in laparoscopic surgery. However, injection of intraperitoneal dexmedetomidine should be used with caution in light of the off-label use. |
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