单剂量酮咯酸用于围术期超前镇痛的meta分析

Meta-analysis of Single Dose Ketorolac on Preemptive Analgesia in Perioperative Period

关键词:  酮咯酸  围手术期  超前镇痛  meta分析

Key words:  ketorolac  perioperative  preemptive analgesia  meta analysis

摘要:

目的 采用meta分析综合评价单剂量酮咯酸用于围术期超前镇痛的有效性及安全性。方法 遵循PRISMA声明指南，全面检索公开发表的随机对照试验，通过meta分析综合评价单剂量全身酮咯酸对术后疼痛、阿片样药物消耗及不良反应的影响。结果 共纳入11项研究，累计606人。Meta分析结果表明术后0，4，8 h的酮咯酸超前镇痛效果明显，术后24 h的酮咯酸超前镇痛效果无统计学差异。酮咯酸超前镇痛可以减少术后阿片类药物（吗啡）的使用[MD=-4.25，95%CI （-8.16，-0.35），P=0.03]，减少恶心、呕吐不良反应的发生[RR=0.68，95%CI （0.51，0.90），P=0.006]，且未增加严重不良反应。结论 现有的临床文献数据表明，酮咯酸用于围手术期超前镇痛效果明确，可减少术后阿片类药物（吗啡）的使用量，同时减少了恶心或呕吐的发生。

Abstract:

OBJECTIVE To evaluate the efficacy and security of a single dose of perioperative ketorolac on postoperative analgesia by meta-analysis. METHODS Followed the PRISMA statement guidelines. A wide search was performed to identify randomized controlled trials that evaluated the effects of a single dose of systemic ketorolac on postoperative pain, opioid consumption and adverse reactions. Meta analysis was performed using a random-effects model. RESULTS Eleven randomized clinical trials with 606 subjects were included. The result showed statistically differences for ketorolac over placebo for 0, 4, and 8 h after surgery, but not at 24 h. Preemptive analgesia with ketorolac could reduce the use of postoperative opioids(morphine)[MD=-4.25, 95%CI(-8.16, -0.35), P=0.03]. Postoperative nausea and vomiting were decreased by ketorolac, with an RR sratio (95%CI) of 0.68 (0.51, 0.90) (P=0.006), and did not increase the occurrence of serious adverse reactions. CONCLUSION The available clinical studys indicate that ketorolac is effective for perioperative advanced analgesia and can reduce postoperative opioid(morphine) usage and also decrease nausea or vomiting.