帕瑞昔布钠在腹腔镜胆囊切除术中超前镇痛的有效性及安全性的Meta分析

背景与目的 伴随着外科快速康复理念发展，围术期的多模式镇痛逐渐被接受。其中超前镇痛是一种常用方法。本研究通过系统回顾和Meta分析判断帕瑞昔布钠超前镇痛在腹腔镜胆囊切除术（LC）中的有效性和安全性。方法 检索中英文数据库，收集比较LC中应用术前静脉使用帕瑞昔布钠（超前镇痛组）与未静脉使用帕瑞昔布钠（空白组）或手术结束时静脉使用帕瑞昔布钠（术毕镇痛组）的随机对照研究或观察性研究。检索时间为建库至2021年5月。在对纳入研究进行方法学质量评价和数据提取后，采用RevMan 5.3和Stata 12.0软件行Meta分析。结果 最终纳入中英文文献共13篇，涉及974例患者。Meta分析结果显示，超前镇痛组的患者术后2、4、6、8、12、24 h可视模拟评分（VAS）均低于空白组（均P<0.05）与术毕镇痛组（部分P<0.05）。超前镇痛组术后需要额外止痛药病例数少于空白组与术毕镇痛组，术后不良反应（恶心、呕吐）发生率低于空白组（均P<0.05）。基于需要额外止痛药病例数与术后不良事件发生率的发表偏倚与敏感度分析显示，无明显的发表偏移存在（均P>0.05），该方法不会改变最初总体分析的结果。结论 静脉使用帕瑞昔布钠超前镇痛在LC中具有良好的镇痛效果、较小的不良反应，为临床多模式镇痛提供了一种安全有效的方法。

Efficacy and safety parecoxib sodium for preemptive analgesia in laparoscopic cholecystectomy: a Meta-analysis

Background and Aims With the development of concept of fast-track surgery, perioperative multimodal analgesia has been gradually accepted. Among them, preemptive analgesia is a common method. This study was conducted to determine the efficacy and safety of parecoxib sodium preemptive analgesia in laparoscopic cholecystectomy (LC) through a systematic review and Meta-analysis.Methods The randomized controlled trails or observational studies comparing the preoperative intravenous injection of parecoxib sodium (preemptive analgesia) and without intravenous use of parecoxib sodium (blank control) or intravenous injection of parecoxib sodium at the end of operation (postoperative analgesia group) in LC were collected by searching several Chinese and English databases. The retrieval time from inception to May 2021. After the quality evaluation and data extraction of the included studies, Meta-analysis was performed by using RevMan 5.1 and Stata 12.0 software.Results Thirteen articles in Chinese and English were finally included, involving 974 patients. Results of Meta-analysis showed that the visual analogue score (VAS) at postoperative 2, 4, 6, 8, 12 and 24 h were lower in preemptive analgesia group than those in blank group (all P<0.05) and postoperative analgesia group (partial P<0.05); the number of patients requiring additional painkillers in preemptive analgesia group was less than that in blank group or postoperative analgesia group, and the incidence of postoperative adverse reactions (nausea and vomiting) in the preemptive analgesia group was lower than that in the blank group (all P<0.05). Results of publication bias sensitivity analysis based on the number of cases requiring additional painkillers and the incidence of postoperative adverse events showed that there was no significant publication bias (both P>0.05), and this method would not change the results of the initial overall analysis.Conclusion Preemptive analgesia with intravenous injection of parecoxib sodium in LC has netter analgesic efficacy with low adverse effect. It provides a safe and effective alternative for clinical multimode analgesia.