围术期静脉注射利多卡因对择期结直肠手术预后的影响：随机对照试验的meta分析
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围术期静脉注射利多卡因对择期结直肠手术预后的影响：随机对照试验的meta分析
翻译：牛振瑛 编辑：冯玉蓉 审校：曹莹
背景：由于利多卡因具有镇痛、抗炎和减少阿片类药物使用的作用，近年来围术期静脉注射利多卡因(IVL)成为研究热点。然而，这些潜在的优势在择期结直肠手术中并未得到很好的证实。
目的：探讨围术期静脉注射利多卡因对择期结直肠手术患者术后转归的影响。
设计：对择期结直肠手术中围术期IVL和安慰剂输注的随机对照试验(RCT)进行meta分析。主要观察指标为术后48h内的疼痛评分。次要观察指标包括胃肠功能恢复时间、术后吗啡用量、吻合口瘘、局麻药毒性和住院时间。
数据来源：检索PubMed、Scopus和Cochrane图书馆数据库从建库至2018年11月5日已发表的文章。
纳入与排除标准：评估围术期IVL与安慰剂在择期结直肠手术成年患者中的作用的随机对照试验则纳入研究。排除标准为儿科患者、非结直肠或急诊手术、非随机对照试验研究或缺乏相关结果测量。
结果：共纳入10项研究(508名患者；265名接受IVL，243名接受安慰剂输注)。IVL与排便时间(平均差值-12.06h，95%CI -17.83 ~ -6.29, I2=93%,P=0.0001)、住院时间(平均差值-0.76 d, 95% CI -1.32 ~ -0.19, I2=45%, P=0.009)及术后早期疼痛评分均显著降低相关，尽管这种差异未达到临床相关差异的阈值。两组的术后排气时间（平均差-5.33 h, 95% CI -11.53 ~ 0.88,I2=90%, P=0.09）、手术部位感染率和吻合口瘘发生率无显著性差异。
结论：本项分析为结直肠手术围术期静脉输注利多卡因的管理提供了一定的支持。然而，鉴于研究异质性和方法学的混合性，还需要进一步的证据来充分阐明其潜在的益处。
原始文献来源： Rollins KE, Javanmard-Emamghissi H, Scott MJ,et,al. The impact of peri-operative intravenous lidocaine on postoperative outcome after elective colorectal surgery：A meta-analysis of randomised controlled trialsEur J Anaesthesiol 2020 Aug;378(8).DOI：10.1097/EJA.0000000000001165
The impact of peri-operative intravenous lidocaine on postoperative outcome after elective colorectal surgery：A meta-analysis of randomised controlled trials
BACKGROUND There has recently been increasing interest in the use of peri-operative intravenous lidocaine (IVL) due to its analgesic, anti-inflammatory and opioid-sparing effects.However, these potential benefits are not well established in elective colorectal surgery.
OBJECTIVES To examine the effect of peri-operative IVL infusion on postoperative outcome in patients undergoing elective colorectal surgery.
DESIGN A meta-analysis of randomised controlled trials (RCTs) comparing peri-operative IVL with placebo infusion in elective colorectal surgery. The primary outcome measure was postoperative pain scores up to 48 h. The secondary outcome measures included time to return of gastrointestinal function, postoperative morphine requirement, anastomotic leak, local anaesthetic toxicity and hospital length of stay.
DATA SOURCES PubMed, Scopus and the Cochrane Library databases were searched on 5 November 2018.
ELIGIBILITY CRITERIA Studies were included if they were RCTs evaluating the role of peri-operative IVL vs. placebo in adult patients undergoing elective colorectal surgery. Exclu-
sion criteria were paediatric patients, noncolorectal or emergency procedures, non-RCT methodology or lack of relevant outcome measures.
RESULTS A total of 10 studies were included (n=508 patients; 265 who had undergone IVL infusion, 243 who had undergone placebo infusion). IVL infusion was associated with a significant reduction in time to defecation (mean difference -12.06 h, 95%CI -17.83 to -6.29, I2=93%,P=0.0001), hospital length of stay (mean difference -0.76 days, 95% CI -1.32 to -0.19, I2=45%, P=0.009) and postoperative pain scores at early time points, although this difference does not meet the threshold for a clinically relevant difference. There was no difference in time to pass flatus (mean difference -5.33 h, 95% CI -11.53 to 0.88,I2=90%, P=0.09), nor in rates of surgical site infection or anastomotic leakage.
CONCLUSION This meta-analysis provides some support for the administration of peri-operative IVL infusion in elective colorectal surgery. However, further evidence is necessary to fully elucidate its potential benefitsinlightofthehighlevelsof study heterogeneity and mixed quality of methodology.
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