Lidocaine vs. Other Local Anesthetics in the Development of Transient Neurologic Symptoms (TNS) Following Spinal Anesthesia: A Meta-Analysis of Randomized Controlled Trials
Lidocaine vs. Other Local Anesthetics in the Development of Transient Neurologic Symptoms (TNS) Following Spinal Anesthesia: A Meta-Analysis of Randomized Controlled Trials
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DOI：
10.3390/jcm9020493
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发表时间：
2020-02-01
影响因子：
3.9
通讯作者：
Ryu, Jung-Hee
中科院分区：
文献类型：
--
作者：
Koo, Chang-Hoon;Shin, Hyun-Jung;Ryu, Jung-Hee
根据先前的荟萃分析，在脊髓麻醉中使用利多卡因可能会增加一过性神经系统症状（TNS）的风险。然而，以前的荟萃分析缺乏一些其他局麻药的数据，因此，仍然需要更多的评价来比较利多卡因对TNS发生的影响。本研究的目的是比较在接受脊髓麻醉的患者中，利多卡因与其他局麻药的TNS风险。共分析了39项随机对照试验，4733例患者。利多卡因组TNS的发生率为10.8%，对照组为2.2%（风险比（RR）4.12，95%置信区间（CI）3.13至5.43，p < 0.001）。在亚组分析中，利多卡因与除甲哌卡因、罗哌卡因或沙美定外的其他局麻药相比，增加了TNS的发生率。与对照组相比，高压（p < 0.001）或等压利多卡因（p < 0.001）组发生TNS的风险较高，但当给予低压利多卡因时，两组之间无差异（p = 1.00）。这项研究证实，利多卡因用于脊麻仍然比大多数其他局麻药更频繁地引起TNS，特别是当使用高压或等压利多卡因时。
The use of lidocaine in spinal anesthesia may increase the risk of transient neurological symptoms (TNS) according to previous meta-analyses. However, the previous meta-analyses lacked data on some other local anesthetics and thus, more evaluations are still needed to compare the effect of lidocaine on the development of TNS. The objective of this study was to compare the risk of TNS according to lidocaine versus other local anesthetics in patients undergoing spinal anesthesia. A total of 39 randomized controlled trials with 4733 patients were analyzed. The incidence of TNS was 10.8% in the lidocaine group and was 2.2% in the control groups (risk ratio (RR) 4.12, 95% confidence interval (CI) 3.13 to 5.43, p < 0.001). In subgroup analysis, lidocaine increased the incidence of TNS compared with other local anesthetics except mepivacaine, ropivacaine or sameridine. The risk of TNS was higher in the hyperbaric (p < 0.001) or isobaric lidocaine (p < 0.001) group compared with the control group, but there were no differences found between the two groups when hypobaric lidocaine was administered (p = 1.00). This study confirmed that lidocaine for spinal anesthesia still causes TNS more frequently than most other local anesthetics, especially when hyperbaric or isobaric lidocaine was used.