局麻药联合右美托咪定腹腔注射对腹腔镜手术后镇痛效果影响的系统评价

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摘要目的评价局麻药单用或联合右美托咪定（DEX）腹腔注射对腹腔镜手术后镇痛效果的影响。方法计算机检索Cochrane Library、PubMed、EMBase、中国生物医学文献数据库、万方数据库、中文数据库知网和维普数据库，收集比较局麻药单用（L组）或联合DEX腹腔注射（LD组）对腹腔镜手术后首次使用补救镇痛药的时间及补救镇痛药总用量等镇痛效果影响的临床随机对照试验。检索时间从建库至2019年8月。提取资料并评价纳入研究的偏倚风险后，采用Revman 5.3软件进行统计分析。结果最终纳入7项研究，共422例患者。分析结果显示，与L组比较，LD组术后首次使用补救镇痛药时间延长[MD = 58.78，95%CI：（23.72，93.83），P = 0.001]，24 h补救镇痛药总用量减少[双氯芬酸：MD = -86.27，95%CI：（-127.95，-44.58），P ＜ 0.0001]，术后肩痛的发生率降低[OR = 0.16，95%CI：（0.08，0.31），P ＜ 0.000 01]；两组恶心[OR = 0.71，95%CI：（0.34，1.47），P = 0.36]、呕吐[OR = 0.40，95%CI：（0.16，1.01），P = 0.05]等不良反应的发生率比较，差异无统计学意义。结论局麻药联合DEX腹腔注射能够提高腹腔镜手术后镇痛效果且不增加不良反应的发生。

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	邓敏佳1 胡丽辉1 黄笑芳1 刘玉玲1 吴友平2

关键词 ：右美托咪定, 腹腔注射, 腹腔镜手术, 术后镇痛, 系统评价

Abstract：Objective To assess the efficacy and safety of intraperitoneal local anesthetic with Dexmedetomidine (DEX) for postoperative analgesia after laparoscopic surgery. Methods The PubMed, EMbase, Cochrane Library, CBM, Wanfang Database, China National Knowledge Infrastructure and VIP for all randomized controlled trials about intraperitoneal local anesthetic alone (group L) or with DEX (group LD) in laparoscopic surgery were searched. The retrieval period was from the establishment of the database to August 2019. Information was extracted and the research of risk of bias was evaluated, data was analyzed by RevMan5.3 software. Results Seven RCTs involving 422 patients were included. The results showed that compared with group L, group LD first use remedy postoperative analgesia drug prolonged [MD = 58.78, 95%CI: (23.72, 93.83), P = 0.001], 24 h remedial reduction total [Diclofenac: MD = -86.27, 95%CI: (-127.95,-44.58), P ＜ 0.0001], the incidence of postoperative shoulder pain reduce [OR = 0.16, 95%CI: (0.08, 0.31), P ＜ 0.000 01]. There was no significant difference in the incidence of adverse reactions such as nausea [OR = 0.71, 95%CI: (0.34, 1.47), P = 0.36], vomiting [OR = 0.40, 95%CI: (0.16,1.01), P = 0.05] between the two groups. Conclusion Intraperitoneal local anesthetic combines with DEX can improve the analgesia effect after laparoscopic surgery without increasing the occurrence of adverse reaction.

Key words： Dexmedetomidine Intraperitoneal Laparoscopic surgery Postoperative analgesia Systematic review

基金资助:广东省广州市科技计划项目（201804010216）。

通讯作者: 吴友平(1986.8-），男，博士，主治医师；研究方向：围术期器官功能保护。

引用本文:

邓敏佳1 胡丽辉1 黄笑芳1 刘玉玲1 吴友平2. 局麻药联合右美托咪定腹腔注射对腹腔镜手术后镇痛效果影响的系统评价[J]. 中国医药导报, 2020, 17(10): 113-117.
DENG Minjia1 HU Lihui1 HUANG Xiaofang1 LIU Yuling1 WU Youping2. Intraperitoneal local anesthetic with Dexmedetomidine for postoperative analgesia after laparoscopic surgery: a systematic review . 中国医药导报, 2020, 17(10): 113-117.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I10/113

[1] Choi JB，Kang K，Song MK，et al. Pain Characteristics after Total Laparoscopic Hysterectomy [J]. Int J Med Sci，2016，13（8）：562-568.
[2] Yong L，Guang B. Intraperitoneal ropivacaine instillation versus no intraperitoneal ropivacaine instillation for laparoscopic cholecystectomy：A systematic review and meta-analysis [J]. Int J Surg，2017，44：229-243.
[3] Mahmoud M，Mason KP. Dexmedetomidine：review，update，and future considerations of paediatric perioperative and periprocedural applications and limitations [J]. Br J Anaesth，2015，115（2）：171-182.
[4] 刘玉玲，吴友平.右美托咪定腹腔给药用于术后镇痛的研究进展[J].中国现代医药杂志，2016，18（8）：91-93.
[5] Ahmed B，Elmawgoud MAA，Doaa R. Antinociceptive Effect of （Á2-Adrenoceptor Agonist） Dexmedetomidine vs Meperidine，Topically，after Laparoscopic Gynecologic Surgery [J]. J Med Sci，2008，8（4）：400-404.
[6] Beder E，Baz MM，Farahat TEM. Intraperitoneal Levobupivacaine Alone or with Dexmedetomidine for Postoperative Analgesia after Laparoscopic Cholecystectomy [J]. Anesth Essays Res，2018，12（2）：355-358.
[7] Chilkoti GT，Kumar M，Mohta M，et al. Comparison of postoperative analgesic efficacy of low-dose bolus intravenous dexmedetomidine and intraperitoneal dexmedetomidine with bupivacaine in patients undergoing laparoscopic cholecystectomy：A randomised，controlled trial [J]. Indian J Anaesth，2019，63（2）：106-113.
[8] Elnabtity AM，Ibrahim M. Intraperitoneal dexmedetomidine as an adjuvant to bupivacaine for postoperative pain management in children undergoing laparoscopic appendectomy：A prospective randomized trial [J]. Saudi J Anaesth，2018，12（3）：399-405.
[9] Fares KM，Mohamed SA，Abd El-Rahman AM，et al. Efficacy and safety of intraperitoneal dexmedetomidine with bupivacaine in laparoscopic colorectal cancer surgery，a randomized trial [J]. Pain Med，2015，16（6）：1186-1194.
[10] Shukla U，Prabhakar T，Malhotra K，et al. Intraperitoneal bupivacaine alone or with dexmedetomidine or tramadol for post-operative analgesia following laparoscopic cholecystectomy：A comparative evaluation [J]. Indian J Anaesth，2015，59（4）：234-239.
[11] Oza VP，Parmar V，Badheka J，et al. Comparative study of postoperative analgesic effect of intraperitoneal instillation of dexmedetomidine with bupivacaine and bupivacaine alone after laparoscopic surgery [J]. Lab Anim，2016， 12（3）：260-264.
[12] Jaschinski T，Mosch CG，Eikermann M，et al. Laparoscopic versus open surgery for suspected appendicitis [J]. Cochrane Database Syst Rev，2018，11：CD001546.
[13] Song T，Kim KH，Lee KW. The Intensity of Postlaparoscopic Shoulder Pain Is Positively Correlated with the Amount of Residual Pneumoperitoneum [J]. J Minim Invasive Gynecol，2017，24（6）：984-989.e981.
[14] Tobias JD. Pain management following laparoscopy：Can we do better? [J]. Saudi J Anaesth，2013，7（1）：3-4.
[15] Abdulla S，Eckhardt R，Netter U，et al. A randomized，double-blind，controlled trial on non-opioid analgesics and opioid consumption for postoperative pain relief after laparoscopic cholecystectomy [J]. Acta Anaesthesiol Belg，2012，63（1）：43-50.
[16] El-Labban GM，Hokkam EN，El-Labban MA，et al. Intraincisional vs intraperitoneal infiltration of local anaesthetic for controlling early post-laparoscopic cholecystectomy pain [J]. J Minim Access Surg，2011，7（3）：173-177.
[17] Thanapal MR，Tata MD，Tan AJ，et al. Pre-emptive intraperitoneal local anaesthesia：an effective method in immediate post-operative pain management and metabolic stress response in laparoscopic appendicectomy，a randomized，double-blinded，placebo-controlled study [J]. ANZ J Surg，2014，84（1/2）：47-51.
[18] Yang YC，Meng QT，Pan X，et al. Dexmedetomidine produced analgesic effect via inhibition of HCN currents [J]. Eur J Pharmacol，2014，740：560-564.
[19] Lee DH，Song T，Kim KH，et al. Incidence，natural course，and characteristics of postlaparoscopic shoulder pain [J]. Surg Endosc，2018，32（1）：160-165.
[20] Bhatia N，Mehta S，Saini V，et al. Comparison of Intraperitoneal Nebulization of Ropivacaine with Ropivacaine-Fentanyl Combination for Pain Control Following Laparoscopic Cholecystectomy：A Randomized，Double-Blind，Placebo-Controlled Trial [J]. J Laparoendosc Adv Surg Tech A，2018，28（7）：839-844.