【原】静脉输注利多卡因用于腹腔镜胆囊切除术后疼痛控制：随机对照试验的Meta分析

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Intravenous lidocaine infusion for pain control after laparoscopic cholecystectomy:A meta-analysis of randomized controlled trials

背景与目的

腹腔镜胆囊切除术（LC）自1987年开创，现已广泛应用于胆石症、胆囊炎和胆绞痛等治疗，美国每年有60万例以上腹腔镜胆囊切除术进行并呈上升趋势，但腹腔镜胆囊切除术引起的术后中重度疼痛会影响患者术后恢复，延迟日间手术后出院并导致再次入院。这篇Meta分析旨在评估静脉输注利多卡因用于腹腔镜胆囊切除术后疼痛管理的有效性和安全性。

方  法

在PubMed（1966年8月-2017年）、Medline（1966年8月-2017年）、Embase（1980年8月-2017年）、ScienceDirect（1985年8月-2017年）和Cochrane图书馆进行系统检索，仅纳入随机对照试验（RCTS）。通过I2统计进行异质性检验，采用固定/随机效应模型，并用Stata.11.0软件进行Meta分析。

结  果

共检索到5例随机对照试验，其中包含274例患者。研究结果显示腹腔镜胆囊切除术后12h（权重平均差[WMD]=0.743, 95% CI:1.246～0.240, P=0.004）、24h（WMD=0.712, 95% CI: 1.239～0.184, P=0.008）、48h（WMD=0.600, 95% CI:0.972～0.229, P=0.002）各组间视觉模拟量表评分存在显著性差异；并且阿片类药物使用量在腹腔镜胆囊切除术后12h(WMD=3.136,95% CI: 5.591～0.680, P=0.012)、24h(WMD=4.739, 95% CI: 8.291～1.188, P=0.009)、48h(WMD=3.408,95% CI: 5.489～1.326, P=0.001)也存在显著性差异。

结  论

静脉输注利多卡因可明显降低腹腔镜胆囊切除术后疼痛评分和阿片类药物使用量，且不良反应较少。

原始文献摘要

Ji BZ, Yuan LL, Ye MW,et al.Intravenous lidocaine infusion for pain control after laparoscopic cholecystectomy  A meta-analysis of randomized controlled trials[J].Medicine (2018) 97:5(e9771)

Background: This meta-analysis aimed to assess the efficiency and safety of intravenous infusion of lidocaine for pain management after laparoscopic cholecystectomy (LC).

Methods: A systematic search was performed in PubMed (August 1966–2017), Medline (August 1966–2017), Embase (August1980–2017), ScienceDirect (August 1985–2017), and the Cochrane Library. Only randomized controlled trials (RCTs) were included.Fixed/random effect model was used according to the heterogeneity tested by I2 statistic. Meta-analysis was performed usingStata.11.0 software.

Results: A total of 5 RCTs were retrieved involving 274 patients. The present meta-analysis indicated that there were significant differences between groups in terms of visual analog scale scores at 12hours (weighted mean difference [WMD]=0.743, 95% CI:1.246 to 0.240, P=.004), 24hours (WMD=0.712, 95% CI: 1.239 to 0.184, P=.008), and 48hours (WMD=0.600, 95% CI:0.972 to 0.229, P=.002) after LC. Significant differences were found regarding opioid consumption at 12hours (WMD=3.136,95% CI: 5.591 to 0.680, P=.012), 24hours (WMD=4.739, 95% CI: 8.291 to 1.188, P=.009), and 48hours (WMD=3.408,95% CI: 5.489 to 1.326, P=.001) after LC.

Conclusion: Intravenous lidocaine infusion significantly reduced postoperative pain scores and opioid consumption after LC. In addition, there were fewer adverse effects in the lidocaine groups. Higher quality RCTs are still required for further research

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