关节周围局部注射镇痛药对全膝关节置换后镇痛的Meta分析

背景：传统全膝关节置换的镇痛方式较多,但这些方法常常带来一些不良事件。 目的：应用循证医学Meta分析评价全膝关节置换过程中关节周围局部注射镇痛药后镇痛效果的安全性及有效性。 方法：通过计算机检索PubMed、Cochrane Library、EMBASE、CNKI、CBM、WANGFANG有关全膝关节置换镇痛的文献,检索年限均为2000-01-01/2011-04-30。纳入所有全膝关节置换镇痛的随机对照试验,两组其他处理措施相同,试验组在对照组的基础上术中关节周围局部注入混合镇痛药。由2名评价者独立进行筛选及资料提取,采用RevMan5.1.2软件对符合质量标准的研究进行Meta分析。 结果与结论：最后共纳入10个研究,合计694例受试患者。进行Meta分析结果显示,与全膝关节置换传统镇痛方式相比,试验组置换后目测类比活动评分较低WMD=-1.04,95%CI(-1.26,-0.82),P < 0.000 01]、置换后目测类比静止评分较低WMD=-0.67,95%CI(-0.81,-0.54),P < 0.000 01]、置换后再镇痛例数少RR=0.26,95%CI(0.17,0.40),P < 0.000 01]、置换后再镇痛吗啡需要量少WMD=-6.89,95%CI(-8.91,-4.86),P < 0.000 01],两组不良事件发生率相差不大RR=0.62,95%CI(0.21,1.84),P=0.39]。当前证据表明,全膝关节置换过程中关节周围局部注射镇痛药是一种有效、安全可靠的镇痛方式,但是疗效和安全性仍需大样本的随机对照试验来验证。

Meta-analysis of analgesic effect of local injection analgesic drugs around joint after total knee arthroplasty

BACKGROUND:There are too many traditional analgesia methods of total knee arthroplasty (TKA), but these methods always bring some adverse events. OBJECTIVE:To evaluate the effectiveness and security of local injection of analgesic drugs around joint during TKA by Meta analysis. METHODS:PubMed, Cochrane Library, EMBASE, CNKI, CBM and WANGFANG database were searched for articles related to analgesic of total knee replacement (2000-01-01/2011-04-30). All randomized controlled trials (RCTs) about the analgesic of TKA were adopted; other treatment measures were all the same in both groups except mixed analgesics were local injected around joint during the TKA in the experimental group. Quality of literatures were critically evaluated and extracted by 2 investigators independently. The statistical analysis was conducted using the RevMan 5.1.2. RESULTS AND CONCLUSION:Ten RCTs involving 694 patients were collected. The results of Meta-analyses showed that compared with the traditional analgesia method, visual analogue scales (VAS) for pain during activity in the post-anesthetic-care (WMD=-1.04, 95%CI (-1.26, -0.82), P < 0.000 01] and the VAS for pain at rest in the post-anesthetic-care WMD=-0.67, 95%CI(-0.81, -0.54), P < 0.000 01] were lower, the number of patient needed analgesia again RR=0.26, 95%CI (0.17, 0.40), P < 0.000 01] and morphine consumption WMD=-6.89, 95%CI (-8.91, -4.86), P < 0.000 01] postoperatively were fewer in the experimental group. There was no significant difference of incidence adverse reactions in the two groups RR=0.62, 95%CI(0.21,1.84), P=0.39]. The current evidence indicated that local injection of analgesic drugs around joint after TKA is an effective and safe methods, but the effectiveness and security still need to be confirmed by RCTs with large sample.