经颅直流电刺激用于术后镇痛：基于随机对照研究的系统评价与荟萃分析*

Efficacy and safety of tDCS for postoperative analgesia: a systematic review and meta-analysis based on randomized controlled trials*

摘要:

目的：系统评价经颅直流电刺激(transcranial Direct Current Stimulation,tDCS)用于术后镇痛的有效性及安全性,为临床实践提供理论依据。方法：遵循PRISMA原则,全面检索 PubMed、Web of Science、Embase、Cochrane图书馆、中国生物医学文献服务系统(Sinomed)、中国国家知识网络基础设施数据库 (CNKI)、万方数据库、维普数据库等8个数据库,搜索有关使用tDCS进行术后镇痛的随机对照试验 (RCT),时限截止至 2023 年 7 月,语言限制为中文和英文。由两位研究者独立评价文献质量、提取数据。采用 RevMan 5.4版本软件进行荟萃分析。主要结局指标为术后吗啡消耗量,次要结局指标为使用视觉模拟评分法 (visual analogue scale, VAS) 或数字评分法 (numerical rating scale, NRS)测量的疼痛评分,安全指标为tDCS相关不良事件。结果：共纳入包括413例患者的10 项RCT研究。荟萃分析结果示：tDCS组的术后吗啡消耗量显著低于对照组(P<0.0001)；按照tDCS电极位置行亚组分析显示,M1区tDCS术后吗啡消耗量低于对照组(P<0.0001),而额叶皮质区tDCS与对照组术后吗啡消耗量无明显差异(P=0.1)；按照tDCS治疗次数行亚组分析示：单次或多次tDCS较对照组均未显示出优势(P=0.48；P=0.31)。在术后总体疼痛评分方面,tDCS组与对照组无明显差异,但可降低术后静息疼痛评分(P<0.0001)；在安全指标方面,两组均未发生严重不良事件。结论：tDCS可减少术后吗啡消耗量,降低术后静息疼痛评分,且无严重相关不良事件发生。

Abstract:

Objective: To conduct a systematic review and meta-analysis assessing the efficacy and safety of transcranial direct current stimulation (tDCS) for postoperative analgesia. Methods: According to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach, PubMed, Web of Science, Embase, Cochrane Library, China Biomedical Documentation Service System (Sinomed), China National Knowledge Network Infrastructure Database (CNKI), WanFang Database, and VIP Database were electronically searched for randomized controlled trials (RCTs) assessing the efficacy and safety of tDCS for postoperative analgesia up to July 2023. Two reviewers assessed the quality of the articles, extracted data independently, and the analysis was performed with RevMan 5.4 software. The primary outcome was the postoperative morphine consumption, the second outcome was the postoperative pain score scaled by visual analogue scale (VAS) or numerical rating scale (NRS), and the safety outcome was the tDCS-related adverse event. Results: Ten RCTs involving 413 patients were included. The meta-analysis revealed that the tDCS could significantly reduce postoperative morphine consumption(P<0.0001). Subgroup analysis indicated that tDCS targeting the primary motor cortex (M1) significantly reduced postoperative morphine consumption (P<0.0001), whereas tDCS targeting the prefrontal cortex did not show the same efficacy (P=0.1). Besides, neither single session nor multiple-session tDCS was effective for reducing postoperative morphine consumption when compared to control group(P=0.48；P=0.31). Additionally, postoperative pain score at rest in tDCS group were lower than that in control group (P<0.0001). In terms of safety outcome,there was no severe adverse event reported in either group. Conclusion: Current evidence shows that tDCS can effectively decrease postoperative morphine consumption and alleviate resting pain scores, while maintaining a low incidence of related mild adverse events.