【罂粟摘要】利多卡因贴片对术后疼痛的影响:一项随机对照试验的Meta分析

利多卡因贴片对术后疼痛的影响:一项随机对照试验的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：潘志军  审校：曹莹

研究背景：多项研究评估了利多卡因贴片(LP)通过局麻药吸收来减轻术后疼痛的作用；然而，这些试验的结果并不一致。本Meta分析旨在确定LP的益处，重点关注其在患者术后镇痛和节省吗啡的效果。  

实验设计：Meta分析。

范围设置：通过选取已发表的随机对照试验(RCTs)进行比较手术后LP与安慰剂或无贴片的镇痛效果。

受试者：11项随机对照试验，共纳入539例患者。

干预措施：我们通过检索电子数据库以确定相关的随机对照试验。

测量方法：主要结果是使用数字评价量表或视觉模拟量表评估术后48小时的疼痛评分，次要结果是术后吗啡用量和副作用。通过计算平均差值(MD)或风险比(RR)及95%置信区间(CI)用以估计效应量。

结果：LP显著降低术后6 h(MD，-1.85;95%CI，−2.98~−0.72;p=0.001)、12h(MD，−1.48;95%CI，−2.07~−0.88;p<0.001)、24h (MD，−1.18;95% CI，−1.65~−0.7;p<0.001)、48h(MD，−1.33;95%CI，−2.46~−0.19;P=0.022)的疼痛评分。相比之下，术后24小时或48小时吗啡用量没有明显影响(MD，−3.48mg;95% CI，−7.94~0.98mg;p=0.127)、(MD，−5.29mg;95%CI，−13.28~2.71;P=0.195)。LP与局部或全身副作用无关(RR,1.00,95%CI,0.67~1.49;p=0.987)、(RR, 0.76, 95% CI, 0.52~1.11, p=0.151)。

结论：与安慰剂或无贴片相比，LP可以降低术后疼痛而无副作用。然而，其节省吗啡的效果尚不清楚。

原始文献来源：

Chang-Hoon Koo，Junkyu Kim, Hyo-Seok Na,et al.The effect of lidocaine patch for postoperative pain: A meta-analysis of randomized controlled trials [J]. (J Clin Anesth 2022 Oct;81).

英文原文     

The effect of lidocaine patch for postoperative pain: A meta-analysis of randomized controlled trials

Abstract

Importance: Study objective: The role of lidocaine patch (LP) in reducing postoperative pain by local anesthetic absorption has been evaluated in several studies; however, these trials have shown inconsistent results. This meta-analysis aimed to identify the benefits of LP, focusing on its pain-reducing and morphine-sparing effect in patients after surgery.

Design: Meta-analysis.

Setting: Published randomized controlled trials (RCTs) comparing the analgesic effects of LP after surgery to those of placebo or no patch.

Patients: Eleven RCTs including 539 patients.

Interventions: We searched electronic databases to identify relevant RCTs.

Measurements: The primary outcome was postoperative pain score up to 48 h assessed using a numerical rating or visual analog scale, and the secondary outcomes were postoperative morphine consumption and side effects. The effect size was estimated by calculating the mean difference (MD) or risk ratio (RR), with 95% confidence interval (CI).

Main results: LP significantly decreased postoperative pain score at 6 h (MD, −1.85; 95% CI, −2.98 to −0.72; p=0.001), 12 h (MD, −1.48; 95% CI, −2.07 to −0.88; p<0.001), 24 h (MD, −1.18; 95% CI, −1.65 to −0.7; p<0.001), and 48 h (MD, −1.33; 95% CI, −2.46 to −0.19; p=0.022). In contrast, no significant effect on post-

operative morphine consumption was observed at 24 h (MD, −3.48 mg; 95% CI, −7.94 to 0.98 mg; p=0.127) or 48 h (MD, −5.29 mg; 95% CI, −13.28 to 2.71; p=0.195). LP was unrelated to local (RR, 1.00, 95% CI, 0.67 to 1.49; p=0.987) or systemic side effects (RR, 0.76, 95% CI, 0.52 to 1.11, p=0.151).

Conclusions: LP can lower postoperative pain without side effects, compared to placebo or no patch. However, its morphine-sparing effect remains unclear.

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