围手术期静脉注射利多卡因与主观恢复质量的关系：一项随机对照试验Meta分析

围手术期静脉注射利多卡因与主观恢复质量的关系：一项随机对照试验Meta分析

贵州医科大学     麻醉与心脏电生理课题组

翻译：潘志军  编辑：陈锐  审核：曹莹

罂 粟 摘 要   

研究目的：评估围手术期静脉注射利多卡因对术后恢复质量（QoR）的影响。

试验设计：随机对照试验（RCT）的荟萃分析。  

范围设置：术后护理。

受试人群：在全身麻醉下接受手术的成年人。

干预措施：围手术期静脉注射利多卡因。

测定方法：主要结果是使用QoR-40问卷测量术后QoR，次要结果包括QoR-40的五个个体维度（即情绪、状态、身体舒适度、心理支持、身体独立性和疼痛）、术中阿片类药物消耗量和慢性术后疼痛风险（CPSP）。

主要结果：检索了从成立到2021年6月的Medline、Cochrane图书馆、谷歌学术和EMBASE数据库。纳入了2012年至2021年发表的14项RCTs，共涉及1148名接受择期手术的患者。分别在术后24小时（12项试验）、72小时（1项试验）和第5天（1项试验）评估QoR-40评分。汇总结果显示，利多卡因组的总体[平均差异（MD）=9.65，95%可信区间（CI）：6.33至12.97；I2=97%；13项随机对照试验；n=1085]和个体维度的QoR-40得分显著高于安慰剂组。亚组分析表明，手术类型、年龄、性别、手术时间、麻醉技术、利多卡因剂量和评估时间对总体QoR-40评分没有显著影响。与安慰剂组相比，静脉注射利多卡因可显著减少术中瑞芬太尼的用量（标准化MD=-0.91，95%可信区间：−1.32至−0.51; I2=86%；10个RCT；n=799）。两组之间发生CPSP的风险没有差异[相对风险（RR）=0.65，95%可信区间：0.33至1.25；I2=58%；4项随机对照试验；n=309]。 

结论：我们的结果验证了静脉注射利多卡因通过使用有效的主观工具提高术后恢复质量和减少全麻下择期手术患者术中瑞芬太尼用量的功效。需要进一步的研究来验证其在急性护理环境中的疗效。

原始文献来源： 

Kuo-Chuan Hung, Chin-Chen Chu, Chung-Hsi Hsing,et al.Association between perioperative intravenous lidocaine and subjective quality of recovery: A meta-analysis of randomized controlled trials[J]. (J Clin Anesth 2021 12;75 ).

英文原文   

Association between perioperative intravenous lidocaine and subjective quality of recovery: A meta-analysis of randomized controlled trials

Abstract

Study objective: To evaluate the impact of perioperative intravenous lidocaine on the quality of recovery (QoR) following surgery.

Design: Meta-analysis of randomized controlled trials (RCTs).

Setting: Postoperative care.

Intervention: Intravenous lidocaine during perioperative period.

Patients: Adults undergoing surgery under general anesthesia.

Measurements: The primary outcome was postoperative QoR measured with QoR-40 questionnaire, while the secondary outcomes included five individual dimensions (i.e., emotional, state, physical comfort, psychological support, physical independence, and pain) of QoR-40, intraoperative opioid consumption, and risk of chronic postsurgical pain (CPSP).

Main results: Medline, Cochrane Library, Google scholar, and EMBASE databases were searched from inception to June 2021. Fourteen RCTs involving 1148 patients in total undergoing elective surgery published from 2012 to 2021 were included. QoR-40 scores were evaluated at postoperative 24 h (12 trials), 72 h (one trial), and Day 5 (one trial), respectively. Pooled results revealed significantly higher global [mean difference (MD) = 9.65, 95% confidence interval (CI): 6.33 to 12.97; I2 = 97%; 13 RCTs; n = 1085] and individual dimension QoR-40 scores in the lidocaine group than those in placebo group. Subgroup analysis demonstrated no significant impact of the type of surgery, age, gender, surgical time, anesthetic technique, lidocaine dosage, and time of assessment on global QoR-40 scores. The use of intravenous lidocaine was associated with a significant reduction in intraoperative remifentanil consumption compared with that in the placebo group (standardized MD = -0.91, 95%CI: −1.32 to −0.51; I2 = 86%; 10 RCTs; n = 799). There was no difference in risk of CPSP between the two groups [relative risk (RR) = 0.65, 95%CI: 0.33 to 1.25; I2 = 58%; 4 RCTs; n = 309].

Conclusion: Our results verified the efficacy of intravenous lidocaine for enhancing postoperative quality of recovery by using a validated subjective tool and reducing intraoperative remifentanil consumption in patients receiving elective surgery under general anesthesia. Further studies are warranted to verify its efficacy in the acute care setting.