Perioperative Use of Gabapentinoids: Comment.
Perioperative Use of Gabapentinoids: Comment.
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DOI：
10.1097/aln.0000000000003665
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发表时间：
2021-04-01
期刊：
影响因子：
8.8
通讯作者：
Guan Z
中科院分区：
文献类型：
--
作者：
Su PP;Guan Z
很高兴在最近一期的《麻醉学》上读到Verret等人的文章。1高质量系统性综述的主要先决条件得到满足;然而，必须解决有关患者、干预、比较和研究设计方法以及综述结论的一些考虑因素。荟萃分析的主要结果汇总了从内镜手术到大手术的高度不同手术的结果。手术后增强恢复和围手术期外科家庭学说中的一个相关问题是手术路线标准化的特异性。2，3在对照组中使用另一种镇痛剂方案的可能性是另一个问题。将加巴喷丁的使用与抗抑郁药、阿片类药物、氯胺酮、非甾体抗炎药、皮质类固醇、苯二氮卓类药物、抗精神病药、抗惊厥药、α 2-肾上腺素能受体激动剂、扑热息痛、褪黑激素和安慰剂进行比较。使用这些药物中的每一种都会引发完全不同的结论，并且除了安慰剂之外，在汇总时不会给出任何关于所研究的干预措施的有效性的想法。在该综述的每项急性和亚急性疼痛汇总指标中发现的不一致性（I2）超过75%（根据科克伦干预措施系统评价手册，具有相当大的异质性），证实了先前的考虑。4在考虑在许多系统性综述方案中进行荟萃分析时，其高度的统计异质性被认为是一个禁止性特征，并引起了对作者宣布的综述结论的许多担忧。统计异质性必须决定如何理解结果，并反映上述临床异质性。
It was a pleasure to read the article from Verret et al. in a recent issue of Anesthesiology. 1 The main prerequisites of a high-quality systematic review were met; however, some considerations about the patient, intervention, comparison, and study design approach applied and the conclusion of the review must be addressed. The main outcomes of the meta-analysis pooled results of highly divergent procedures, from endoscopic procedures to major surgeries. A relevant issue in both the Enhanced Recovery after Surgery and the Perioperative Surgical Home doctrines is the specificity of surgical route standardization. 2, 3 The possibility of another analgesic regiment being used in the comparator group is another concern. The use of gabapentin was compared with antidepressants, opioids, ketamine, nonsteroidal anti-inflammatory drugs, corticosteroids, benzodiazepines, neuroleptics, anticonvulsant, α2-adrenergic receptor agonists, paracetamol, melatonin, and placebo. The use of each of these agents incites completely different conclusions, and—with the exception of the placebo—would not give any idea about the effectiveness of the studied intervention when pooled.Beyond the clinical heterogeneity, the statistical heterogeneity is also a major issue. The inconsistency (I2) over 75%(considerable heterogeneity according the Cochrane Handbook for Systematic Reviews of Interventions) found in every acute and subacute pain summary measure of the review confirms the previous considerations. 4 Its high level of statistical heterogeneity is considered a prohibitive feature when considering performing a meta-analysis in many systematic review protocols and raises many concerns about the conclusions of the review announced by the authors. That statistical heterogeneity must dictate how the results are understood and reflects the aforementioned clinical heterogeneity.