Walker Kevin J, McGrattan Ken, Aas-Eng Kristine, Smith Andrew F
Department of Anaesthetics, Ayr Hospital, Dalmellington Road, Ayr, Ayrshire, UK, KA6 6DX.
Cochrane Database Syst Rev. 2009 Oct 7(4):CD006459. doi: 10.1002/14651858.CD006459.pub2.
Peripheral nerve blocks can be performed using ultrasound guidance. It is not yet clear whether this method of nerve location has benefits over other existing methods.
To assess whether the use of ultrasound to guide peripheral nerve blockade has any advantages over other methods of peripheral nerve location.
We searched the following databases for relevant published trials: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 3); MEDLINE (1966 to July 2008); EMBASE (1974 to July 2008); ISI Web of Science (1945 to 2008 ); CINAHL (1982 to July 2008); and LILACS (1980 to July 2008). We also handsearched meeting supplements.
We included all identified randomized controlled trials (RCTs) comparing ultrasound-guided peripheral nerve block with at least one other method of nerve location.
Two authors independently assessed trial quality and extracted data. We attempted to contact study authors for additional information, where necessary.
We included 18 trials containing data from 1344 patients. Ten trials assessed upper limb blocks and eight assessed lower limb blocks. Most compared ultrasound with peripheral nerve stimulation. All trials were assessed as having a moderate risk of bias due to inability to blind the practitioner. Meta-analysis was not performed because of the variety of blocks, techniques, and outcomes, and the review was based on the authors' assessment of the trials. Ultrasound guidance produced similar success rates in providing surgical anaesthesia (72% to 98.8%) when compared with peripheral nerve stimulation (58% to 93.1%). Major complication rates were low in all studies; however, the use of ultrasound appeared to reduce the incidence of vascular puncture or haematoma formation. Differences in study methodology made it difficult to compare block characteristics, however ultrasound improved quality of sensory block in six studies and motor block in four studies. Block onset time was found to be improved in six out of the 10 studies where this was assessed. Two studies assessed volume of local anaesthetic required and both found a significant reduction was possible when ultrasound was used. Ten studies assessed block performance time and five found a significant reduction with ultrasound, the mean difference in time taken was 1.5 to 4.8 minutes.
AUTHORS' CONCLUSIONS: In experienced hands, ultrasound provides at least as good success rates as other methods of peripheral nerve location. Individual studies have demonstrated that ultrasound may reduce complication rates and improve quality, performance time, and time to onset of blocks. Due to wide variations in study outcomes we chose not to combine the studies in our analysis.
外周神经阻滞可在超声引导下进行。目前尚不清楚这种神经定位方法是否比其他现有方法更具优势。
评估使用超声引导外周神经阻滞是否比其他外周神经定位方法具有任何优势。
我们检索了以下数据库以查找相关的已发表试验：Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆》2008年第3期）；医学期刊数据库（MEDLINE，1966年至2008年7月）；荷兰医学文摘数据库（EMBASE，1974年至2008年7月）；科学引文索引（ISI Web of Science，1945年至2008年）；护理学与健康领域数据库（CINAHL，1982年至2008年7月）；以及拉丁美洲和加勒比卫生科学数据库（LILACS，1980年至2008年7月）。我们还手工检索了会议增刊。
我们纳入了所有已识别的随机对照试验（RCT），这些试验将超声引导外周神经阻滞与至少一种其他神经定位方法进行了比较。
两位作者独立评估试验质量并提取数据。如有必要，我们试图联系研究作者以获取更多信息。
我们纳入了18项试验，包含来自1344名患者的数据。10项试验评估了上肢阻滞，8项评估了下肢阻滞。大多数试验将超声与外周神经刺激进行了比较。由于无法使操作者设盲，所有试验均被评估为存在中度偏倚风险。由于阻滞类型、技术和结果的多样性，未进行荟萃分析，本综述基于作者对试验的评估。与外周神经刺激（成功率为58%至93.1%）相比，超声引导在提供手术麻醉方面的成功率相似（72%至98.8%）。所有研究中的主要并发症发生率都很低；然而，使用超声似乎降低了血管穿刺或血肿形成的发生率。研究方法的差异使得难以比较阻滞特征，不过在6项研究中超声改善了感觉阻滞质量，在4项研究中改善了运动阻滞质量。在评估这一指标的10项研究中，有6项发现阻滞起效时间有所改善。两项研究评估了所需局部麻醉药的体积，均发现使用超声时可显著减少用量。10项研究评估了阻滞操作时间，其中5项发现使用超声时操作时间显著缩短，所用时间的平均差异为1.5至4.8分钟。
在经验丰富的操作者手中，超声提供的成功率至少与其他外周神经定位方法一样好。个别研究表明，超声可能降低并发症发生率，并改善阻滞质量、操作时间和起效时间。由于研究结果差异很大，我们在分析中未选择合并这些研究。
