摘要
目的采用Meta分析评估低剂量纳洛酮(NAL)作为局麻药佐剂(NL)对臂丛神经阻滞(BPB)镇痛效果的影响。方法计算机检索PubMed、Web of Science、Cochrane Library、Embase、中国知网、万方医学网和维普资讯数据库。纳入比较低剂量NL和单独使用局麻药(LA)用于BPB对镇痛效果影响的随机对照试验(RCT)。应用R studio软件调用“meta”“metafor”“dmetar”程序包进行Meta分析,选择固定或随机效应模型。根据不同NAL剂量和LA类型进行亚组分析,利用影响分析或亚组分析监测异质性。当纳入文献≥10篇时进行Egger检验分析发表偏倚。结果共纳入9篇文献,623例患者。主要结局指标:与单独使用LA比较,低剂量NL用于BPB能降低术后24 h补救镇痛药用量[标准均数差(SMD)=-1.32,95%置信区间(CI)-2.15~-0.49,P<0.01],延长术后首次使用镇痛药时间(SMD=2.24,95%CI 0.82~3.67,P<0.01)。次要结局指标:与单独使用LA比较,低剂量NL用于BPB能延长感觉阻滞持续时间(SMD=2.97,95%CI 2.26~3.69,P<0.01)和运动阻滞持续时间(SMD=1.93,95%CI 1.31~2.54,P<0.01),并降低术后不良反应发生率[比值比(OR)=0.44,95%CI 0.33~0.58,P<0.01]。但低剂量NL用于BPB不能缩短感觉阻滞起效时间[均数差(MD)=0.28,95%CI-0.18~0.74,P=0.23],且延长了运动阻滞起效时间(MD=0.64,95%CI 0.15~1.12,P=0.01)。由于纳入文献数量少于10篇,未进行Egger检验分析发表偏倚。结论低剂量NL用于BPB可能有效地延长镇痛时间、增强镇痛效果,尤其作为使用罗哌卡因(LP)佐剂时,但在加速起效时间方面,低剂量NL似乎无法达到与其他常见佐剂相当的效果。基于现有的研究结果,建议使用10μg的NAL剂量,但仍需进一步的临床研究来确认最佳剂量和安全性。
Objective To evaluate the effect of low-dose naloxone(NAL)as an adjuvant to local anesthetics(NL)on the analgesic effect of brachial plexus block(BPB).Methods A computer-based search was conducted in PubMed,Web of Science,Cochrane Library,Embase,China National Knowledge Infrastructure(CNKI),Wanfang,and VIP databases.Randomized controlled trial(RCT)comparing the effects of low-dose NL and local anesthetics(LA)alone on BPB analgesia were included.Meta-analysis was performed using R Studio software,calling the“meta”“metafor”and“dmetar”packages,with either a fixed or random effects model selected.Subgroup analysis was performed based on different naloxone(NAL)doses and LA types,using influence analysis or subgroup analysis to monitor heterogeneity.Egger′s test was conducted to analyze publication bias when the number of included studies was≥10.Results Nine studies involving 623 patients were included.Primary outcomes:compared with LA alone,low-dose NL in BPB reduced postoperative 24-hour rescue analgesic consumption[standardized mean difference(SMD)=-1.32(95%confidence interval(CI)-2.15,-0.49),P<0.01],prolonged the time to first analgesic use[SMD=2.24(95%CI 0.82,3.67),P<0.01].Secondary outcomes:Compared with LA alone,low-dose NL in BPB increased the duration of sensory[SMD=2.97(95%CI 2.26,3.69),P<0.01]and motor blockade[SMD=1.93(95%CI 1.31,2.54),P<0.01].It also reduced the incidence of postoperative adverse reactions[odds ratio(OR)0.44(95%CI 0.33,0.58),P<0.01].However,low-dose NL did not shorten the sensory block duration[mean difference(MD)=0.28(95%CI-0.18,0.74),P=0.23]and delayed the onset of motor block[MD=0.64(95%CI 0.15,1.12),P=0.01].Egger′s test was not performed due to the limited number of included studies(n<10).Conclusions Low-dose NL for BPB may effectively prolong the duration of analgesia and enhance the analgesic effect,especially when used as an adjuvant with ropivacaine(LP).However,low-dose NL seems to be less effective in accelerating the onset time compared with other common adjuvants.Based on the current research,a dose of 10μg of NAL is recommended,but further clinical studies are needed to confirm the optimal dosage and safety.
作者
徐宁
王晓东
荣伟
Xu Ning;Wang Xiaodong;Rong Wei(Department of Anesthesiology,Weihai Central Hospital Affiliated to Qingdao University,Weihai 264400,China;Department of Anesthesiology,Weihai Municipal Hospital,Weihai 264200,China)
出处
《国际麻醉学与复苏杂志》
2026年第1期40-50,共11页
International Journal of Anesthesiology and Resuscitation
基金
吴阶平医学基金会-急性疼痛优化管理专项研究项目(第二期)(320.6750.2024-15-90)。
