保护性镇痛对截肢后幻肢痛发生率影响的Meta分析

doi:10.3969/j.issn.1006-9771.2017.12.016

《中国康复理论与实践》 ›› 2017, Vol. 23 ›› Issue (12): 1450-1458.doi: 10.3969/j.issn.1006-9771.2017.12.016

保护性镇痛对截肢后幻肢痛发生率影响的Meta分析

熊巍², 张军卫², 王增春², 任自刚², 王强²

1.中国康复研究中心北京博爱医院,a.麻醉科;b.脊柱脊髓外科,北京市100068;
2.首都医科大学康复医学院,北京市 100068。

收稿日期:2017-07-14 修回日期:2017-08-23 出版日期:2017-12-25 发布日期:2017-12-28
通讯作者: 张军卫(1966-),男,汉族,辽宁铁岭市人,博士,主任医师,副教授,主要研究方向：脊柱脊髓外科疾病诊治。王强(1968-),男,汉族,浙江杭州市人,博士,主任医师,主要研究方向：临床麻醉与疼痛治疗。E-mail: 13910158172@163.com (张军卫);13801032889@163.com (王强)。
作者简介:熊巍(1974-),女,汉族,北京市人,主治医师,主要研究方向：临床麻醉与疼痛治疗。

Effect of Protective Analgesia on Incidence of Phantom Limb Pain after Amputation: A Meta-analysis

XIONG Wei², ZHANG Jun-wei², WANG Zeng-chun², REN Zi-gang², WANG Qiang²

1.a. Department of Anesthesiology; b. Department of Spine and Spinal Cord Surgery, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China;
2.Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China

Received:2017-07-14 Revised:2017-08-23 Published:2017-12-25 Online:2017-12-28
Contact: ZHANG Jun-wei, WANG Qiang. E-mail: 13910158172@163.com (ZHANG Jun-wei);13801032889@163.com (WANG Qiang)

摘要/Abstract

摘要： 目的系统评价保护性镇痛对截肢后幻肢痛发生率的影响。方法检索建库至2017年6月Cochrane Library、PubMed、Embase、Web of Science、OVID、Science Direct数据库,收集围术期保护性镇痛防治截肢后幻肢痛的临床研究进行评价。由两位独立研究人员根据纳入与排除标准筛选文献并进行质量评价后,提取文献中的相关资料,包括一般资料和幻肢痛发生率,利用RevMan 5.3软件进行Meta分析。结果最终筛选出6篇符合条件的文献。术后随访1个月期共纳入256例患者,其中对照组129例,实验组127例。术后随访6个月期共纳入232例患者,其中对照组118例,实验组114例。术后随访12个月期共纳入118例患者,其中对照组60例,实验组58例。采用围术期保护性镇痛方式进行干预后术后1个月[RD=-0.21, 95%CI (-0.38, -0.04), Z=2.47, P=0.01]和术后6个月[RD=-0.28, 95%CI (-0.52, -0.05), Z=2.37, P=0.02]的幻肢痛发生率低于对照组,而术后12个月的幻肢痛发病率两组之间无显著性差异[RD=-0.20, 95%CI (-0.48, 0.09), Z=1.35, P=0.18]。结论围术期保护性镇痛能够预防截肢后近期和中期幻肢痛的发生率,但远期效果需要做进一步观察。

关键词: 围术期, 保护性镇痛, 截肢, 幻肢痛, 前瞻性研究, Meta分析

Abstract: Objective To systemically evaluate the effect of protective analgesia on preventing phantom limb pain (PLP) after amputation. Methods Published articles from the earliest date available to June, 2017 were recalled from Cochrane Library, PubMed, Embase, Web of Science, OVID, and Science Direct to collect prospective studies using protective analgesia in perioperative period to prevent PLP after amputation. Two reviewers screened literatures referring to studies according to the inclusion and exclusion criteria, and assessed the quality of them. Data of general information and incidence of PLP in the follow-up period were extracted and analyzed with RevMan 5.3 software. Results Six studies were included with a total of 256 patients in the one-month follow-up period including 127 cases in the protective analgesia group (group P) and 129 cases in the control group (group C), a total of 232 patients in the six-month follow-up period including 114 cases in group P and 118 cases in group C, and a total of 118 patients in the twelve-month follow-up period including 58 cases in group P and 60 cases in group C. The incidence of PLP were lower in group P than those in group C in the one-month follow-up period (RD=-0.21, 95%CI [-0.38, -0.04], Z=2.47, P=0.01) and in the six-month follow-up period (RD=-0.28, 95%CI [-0.52, -0.05], Z=2.37, P=0.02), and it was not significant in the twelve-month follow-up period (RD=-0.20, 95%CI [-0.48, 0.09], Z=1.35, P=0.18). Conclusion Protective analgesia in perioperative period can prevent against PLP after amputation in the recent time, however, it needs further observation in long-term.

Key words: perioperative period, protective analgesia, amputation, phantom limb pain, prospective study, meta-analysis

中图分类号:

R687.5

熊巍, 张军卫, 王增春, 任自刚, 王强. 保护性镇痛对截肢后幻肢痛发生率影响的Meta分析[J]. 《中国康复理论与实践》, 2017, 23(12): 1450-1458.

XIONG Wei, ZHANG Jun-wei, WANG Zeng-chun, REN Zi-gang, WANG Qiang. Effect of Protective Analgesia on Incidence of Phantom Limb Pain after Amputation: A Meta-analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2017, 23(12): 1450-1458.

参考文献

[1] Luo Y, Anderson TA. Phantom limb pain: a review [J]. Int Anesthesiol Clin, 2016, 54(2): 121-139.
[2] Ahmed A, Bhatnagar S, Mishra S, et al. Prevalence of phantom limb pain, stump pain, and phantom limb sensation among the amputated cancer patients in india: a prospective, observational study [J]. Indian J Palliat Care, 2017, 23(1): 24-35.
[3] Rathore FA, Ayaz SB, Mansoor SN, et al. Demographics of lower limb amputations in the pakistan military: a single center, three-year prospective survey [J]. Cureus, 2016, 8(4): e566.
[4] Richardson C, Crawford K, Milnes K, et al. A clinical evaluation of postamputation phenomena including phantom limb pain after lower limb amputation in dysvascular patients [J]. Pain Manag Nurs, 2015, 16(4): 561-569.
[5] Aldington D, Small C, Edwards D, et al. A survey of post-amputation pains in serving military personnel [J]. J R Army Med Corps, 2014, 160(1): 38-41.
[6] Anghelescu DL, Kelly CN, Steen BD, et al. Mirror Therapy for phantom limb pain at a pediatric oncology institution [J]. Rehabil Oncol, 2016, 34(3): 104-110.
[7] Alviar MJ, Hale T, Dungca M. Pharmacologic interventions for treating phantom limb pain [J]. Cochrane Database Syst Rev, 2016, 10: CD006380.
[8] Economides JM, DeFazio MV, Attinger CE, et al. Prevention of painful neuroma and phantom limb pain after transfemoral amputations through concomitant nerve coaptation and collagen nerve wrapping [J]. Neurosurgery, 2016, 79(3): 508-513.
[9] Huang CY, Hsu KH, Chen JH, et al. Treating severe phantom limb pain by applying far infrared ray to 'phantom limb' [J]. J Formos Med Assoc, 2016, 115(3): 215-216.
[10] Lee PM, So Y, Park JM, et al. Spinal cauda equina stimulation for alternative location of spinal cord stimulation in intractable phantom limb pain syndrome: a case report [J]. Korean J Pain, 2016, 29(2): 123-128.
[11] Thieme H, Morkisch N, Rietz C, et al. The Efficacy of movement representation techniques for treatment of limb pain&#x#x02013;a systematic review and meta-analysis [J]. J Pain, 2016, 17(2): 167-180.
[12] Yin Y, Zhang L, Xiao H, et al. The pre-amputation pain and the postoperative deafferentation are the risk factors of phantom limb pain: a clinical survey in a sample of Chinese population [J]. BMC Anesthesiol, 2017, 17(1): 69.
[13] Borghi B, D'Addabbo M, White PF, et al. The use of prolonged peripheral neural blockade after lower extremity amputation: the effect on symptoms associated with phantom limb syndrome [J]. Anesth Analg, 2010, 111(5): 1308-1315.
[14] Bach S, Noreng MF, Tjellden NU. Phantom limb pain in amputees during the first 12 months following limb amputation, after preoperative lumbar epidural blockade [J]. Pain, 1988, 33(3): 297-301.
[15] Warner NS, Warner MA, Moeschler SM, et al. Pain management in four-limb amputation: a case report [J]. Pain Pract, 2015, 15(7): E76-E80.
[16] Jahangiri M, Jayatunga AP, Bradley JW, et al. Prevention of phantom pain after major lower limb amputation by epidural infusion of diamorphine, clonidine and bupivacaine [J]. Ann R Coll Surg Engl, 1994, 76(5): 324-326.
[17] Wilson JA, Nimmo AF, Fleetwood-Walker SM, et al. A randomised double blind trial of the effect of pre-emptive epidural ketamine on persistent pain after lower limb amputation [J]. Pain, 2008, 135(1-2): 108-118.
[18] Sahin SH, Colak A, Arar C, et al. A retrospective trial comparing the effects of different anesthetic techniques on phantom pain after lower limb amputation [J]. Curr Ther Res Clin Exp, 2011, 72(3): 127-137.
[19] Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? [J]. Control Clin Trials, 1996, 17(1):1-12.
[20] Schulz KF, Chalmers I, Hayes RJ, et al. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials [J]. JAMA, 1995, 273(5): 408-412.
[21] Slim K, Nini E, Forestier D, et al. Methodological Index for Non-randomized Studies (MINORS): development and validation of a new instrument [J]. ANZ J Surg, 2003, 73(9): 712-716.
[22] Lambert A, Dashfield A, Cosgrove C, et al. Randomized prospective study comparing preoperative epidural and intraoperative perineural analgesia for the prevention of postoperative stump and phantom limb pain following major amputation [J]. Reg Anesth Pain Med, 2001, 26(4): 316-321.
[23] Hayes C, Armstrong-Brown A, Burstal R. Perioperative intravenous ketamine infusion for the prevention of persistent post-amputation pain: a randomized, controlled trial [J]. Anaesth Intensive Care, 2004, 32(3): 330-338.
[24] Karanikolas M, Aretha D, Tsolakis I, et al. Optimized perioperative analgesia reduces chronic phantom limb pain intensity, prevalence, and frequency: a prospective, randomized, clinical trial [J]. Anesthesiology, 2011, 114(5): 1144-1154.
[25] Schley M, Topfner S, Wiech K, et al. Continuous brachial plexus blockade in combination with the NMDA receptor antagonist memantine prevents phantom pain in acute traumatic upper limb amputees [J]. Eur J Pain, 2007, 11(3): 299-308.
[26] Nikolajsen L, Ilkjaer S, Christensen JH, et al. Randomised trial of epidural bupivacaine and morphine in prevention of stump and phantom pain in lower-limb amputation [J]. Lancet, 1997, 350(9088): 1353-1357.
[27] Tilak M, Isaac SA, Fletcher J, et al. Mirror therapy and transcutaneous electrical nerve stimulation for management of phantom limb pain in amputees &#x#x02013;a single blinded randomized controlled trial [J]. Physiother Res Int, 2016, 21(2): 109-115.
[28] Leskowitz E. Phantom limb pain: an energy/trauma model [J]. Explore (NY), 2014, 10(6): 389-397.
[29] Vardeh D, Mannion RJ, Woolf CJ. Toward a mechanism-based approach to pain diagnosis [J]. J Pain, 2016, 17(9 Suppl): T50-T69.
[30] Hsu E, Cohen SP. Postamputation pain: epidemiology, mechanisms, and treatment [J]. J Pain Res, 2013, 6: 121-136.
[31] Rosero EB, Joshi GP. Preemptive, preventive, multimodal analgesia: what do they really mean? [J]. Plast Reconstr Surg, 2014, 134(4 Suppl 2): 85S-93S.
[32] Penprase B, Brunetto E, Dahmani E, et al. The efficacy of preemptive analgesia for postoperative pain control: a systematic review of the literature [J]. AORN J, 2015, 101(1): 94-105, e108.
[33] Suzuki H. Recent Topics in the management of pain: development of the concept of preemptive analgesia [J]. Cell Transplant, 1995, 4(1): 3-6.
[34] Aida S, Fujihara H, Taga K, et al. Involvement of presurgical pain in preemptive analgesia for orthopedic surgery: a randomized double blind study [J]. Pain, 2000, 84(2-3): 169-173.
[35] Becotte A, de Medicis E, Lapie V, et al. Preoperative continuous sciatic nerve block for perioperative analgesia and for phantom limb prevention [J]. J Clin Anesth, 2012, 24(3): 256-257.
[36] Raichle KA, Osborne TL, Jensen MP, et al. Preoperative state anxiety, acute postoperative pain, and analgesic use in persons undergoing lower limb amputation [J]. Clin J Pain, 2015, 31(8): 699-706.
[37] Roullet S, Nouette-Gaulain K, Biais M, et al. Preoperative opioid consumption increases morphine requirement after leg amputation [J]. Can J Anaesth, 2009, 56(12): 908-913.
[38] Hirsh AT, Dillworth TM, Ehde DM, et al. Sex differences in pain and psychological functioning in persons with limb loss [J]. J Pain, 2010, 11(1): 79-86.
[39] Kelle B, Kozanoglu E, Bicer OS, et al. Association between phantom limb complex and the level of amputation in lower limb amputee [J]. Acta Orthop Traumatol Turc, 2017, 51(2): 142-145.

保护性镇痛对截肢后幻肢痛发生率影响的Meta分析

Effect of Protective Analgesia on Incidence of Phantom Limb Pain after Amputation: A Meta-analysis

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