右美托咪定与局麻药腹腔内滴注在腹腔镜胆囊切除术中的效果:随机试验的系统评价和荟萃分析

贵州医科大学    麻醉与心脏电生理课题组

翻译：王婷婷          编辑：王波          审校：曹莹


目的
背景jbhb

右美托咪定(DEX)作为辅助剂经鞘内、神经周和腹腔注射可增强局麻药(LAs)的镇痛作用。许多研究在腹腔镜胆囊切除术(LC)中使用DEX与LAs腹腔内滴注来缓解术后疼痛。我们进行了一项系统回顾和荟萃分析，以综合证据，证明在LC患者中腹腔注射DEX作为LAs辅助剂的有效性和安全性。

方法


对MEDLINE、PubMed、EMBASE和Cochrane图书馆数据库进行全面的文献检索，以确定在LC期间患者腹腔注射DEX联合LAs的随机对照试验。对结果进行meta分析和敏感性分析。我们还进行了亚组分析，以调查异质性的来源。Egger检验用于检查发表偏倚。

结果


纳入11项随机对照试验，共890例患者。我们发现，在LAs中加入DEX可显著降低术后6个时间点(0.5、1、2、4、12和24 h)的疼痛评分，并显著延长患者第一次要求镇痛的时间。此外，实验组术后24小时镇痛药用量减少，恶心呕吐发生率无显著差异。

【罂粟摘要】右美托咪定与局麻药腹腔内滴注在腹腔镜胆囊切除术中的效果:随机试验的系统评价和荟萃分析

结论


      我们的研究结果表明，腹腔内滴注DEX与LAs可以减轻术后疼痛，延长LC后首次请求镇痛的时间。

原始文献来源：Sun C, He Z, Feng B, Huang Y, Liu D, Sun Z. Effect of Intraperitoneal Instillation of Dexmedetomidine With Local Anesthetics in Laparoscopic Cholecystectomy: A Systematic Review and Meta-analysis of Randomized Trials. Surg Laparosc Endosc Percutan Tech. 2024 Apr 1;34(2):222-232. doi: 10.1097/SLE.0000000000001262. PMID: 38359350.

Effect of Intraperitoneal Instillation of DexmedetomidineWith Local Anesthetics in Laparoscopic Cholecystectomy:A Systematic Review and Meta-analysis of Randomized Trials

Objective: Dexmedetomidine (DEX) can strengthen the analgesiceffects of local anesthetics (LAs) when used as an adjuvant throughintrathecal, perineural, and intraperitoneal routes. Many studieshave used intraperitoneal instillation of DEX with LAs in laparo-scopic cholecystectomy (LC) to relieve postoperative pain. Weperformed a systematic review and meta-analysis to synthesizeevidence of the efficacy and safety of intraperitoneal instillation ofDEX as an adjuvant of LAs in patients undergoing LC.

Methods: A comprehensive literature search of the MEDLINE,PubMed, EMBASE, and Cochrane Library databases was per-formed to identify randomized controlled trials in which patientsreceived intraperitoneal instillation of DEX combined with LAsduring LC. A meta-analysis and sensitivity analysis of the resultswere conducted. We also performed a subgroup analysis to inves-tigate the source of heterogeneity. The Egger test was used to checkfor publication bias.

Results: Eleven randomized controlled trials involving 890 patientswere analyzed. We found that the addition of DEX to LAs sig-nificantly decreased pain scores at six postoperative time points (0.5,1, 2, 4, 12, and 24 h) and significantly prolonged the time to the firstanalgesic request by patients. In addition, 24-hour postoperativeanalgesic consumption was decreased in the experimental group,and no significant difference in the incidence of nausea and vomitingwas observed.

Conclusion: Our findings indicate that intraperitoneal instillation ofDEX with LAs can reduce postoperative pain and prolong the timeto first request analgesia after LC.

END