Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada.
Anesth Analg. 2011 Sep;113(3):596-604. doi: 10.1213/ANE.0b013e3182223397. Epub 2011 Jun 3.
Ultrasound (US) guidance for peripheral nerve blockade has gained popularity worldwide. The reported benefits of real-time sonographic visualization compared with traditional nerve localization techniques generally apply to procedural and technical block-related outcomes whereas acute pain-related outcomes are featured less prominently. In this review, we evaluated the effect of US guidance compared with traditional nerve localization techniques for interventional management of acute pain and acute pain-related outcomes.
We performed a systematic search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Clinical Trials (from January 1990 to January 2011) to identify randomized controlled trials evaluating the effects of US guidance on acute pain and related outcomes compared with traditional nerve localization techniques. Studies were excluded if they did not report at least one of the following acute pain outcomes: pain severity, opioid consumption, sensory block duration, and time to first analgesic request. Related outcomes were classified as follows: patient related (opioid-related adverse effects, patient satisfaction, postoperative cognitive deficit); anesthesia related (unwanted motor block, perineural catheter failure, morbidity, development of chronic pain); surgery related (hospital readmission, ability to ambulate); and hospital related (length of stay, cost). Promising novel applications of US guidance for acute pain management were also sought for discussion purposes.
We identified 23 randomized controlled trials, including 1674 patients, that compared US guidance with and without peripheral nerve stimulation with peripheral nerve stimulation alone or anatomical landmark techniques. Of the 16 studies that evaluated pain severity, 8 reported improvement with US guidance; however, only 1 study reported a difference between US guidance and the comparator of >1 interval on the numeric rating pain scale. Eight studies evaluated sensory block duration and 3 of these reported prolonged block duration with US guidance. Seven studies evaluated opioid consumption, of which 3 reported a reduction with US guidance. Three studies evaluated time to first analgesic request, of which 2 favored US guidance. We uncovered no significant differences between US guidance and traditional nerve localization techniques for any other related outcome. US guidance was not found to be inferior compared with traditional nerve localization techniques for any outcome. Nonrandomized data suggest that US-guided transversus abdominis plane blocks may offer analgesic benefit over standard analgesic therapy, but has not been compared with an anatomical landmark technique.
At present, there is insufficient evidence in the contemporary literature to define the effect of US guidance on acute pain and related outcomes compared with traditional nerve localization techniques for interventional acute pain management.
超声（US）引导在周围神经阻滞中的应用已在全球范围内得到普及。与传统的神经定位技术相比，实时超声可视化的益处通常适用于程序和技术阻滞相关的结果，而急性疼痛相关的结果则不太突出。在本综述中，我们评估了超声引导与传统神经定位技术在急性疼痛的介入管理中的效果，以及急性疼痛相关的结果。
我们对 MEDLINE、EMBASE 和 Cochrane 对照临床试验中央注册库（1990 年 1 月至 2011 年 1 月）进行了系统检索，以确定评估超声引导与传统神经定位技术在急性疼痛及相关结果方面的效果的随机对照试验。如果研究没有报告以下至少一种急性疼痛结果，我们则将其排除：疼痛严重程度、阿片类药物消耗、感觉阻滞持续时间和首次镇痛请求时间。相关结果分为以下几类：患者相关（阿片类药物相关不良反应、患者满意度、术后认知障碍）；麻醉相关（意外运动阻滞、神经周围导管失败、发病率、慢性疼痛的发展）；手术相关（医院再入院、活动能力）；以及医院相关（住院时间、成本）。还寻找了超声引导在急性疼痛管理方面的新的有前途的应用，以便进行讨论。
我们确定了 23 项随机对照试验，共纳入 1674 例患者，比较了超声引导联合和不联合外周神经刺激与外周神经刺激单独或解剖标志技术的效果。在 16 项评估疼痛严重程度的研究中，有 8 项报告了超声引导的改善；然而，只有 1 项研究报告了超声引导与比较组之间的差异大于数字评分疼痛量表上的 1 个间隔。8 项研究评估了感觉阻滞持续时间，其中 3 项报告了超声引导的阻滞持续时间延长。7 项研究评估了阿片类药物消耗，其中 3 项报告了阿片类药物消耗减少。3 项研究评估了首次镇痛请求的时间，其中 2 项研究支持超声引导。我们没有发现超声引导与传统神经定位技术在任何其他相关结果上存在显著差异。与传统神经定位技术相比，超声引导在任何结果上都没有显示出劣势。非随机数据表明，超声引导的腹横肌平面阻滞可能比标准镇痛治疗提供更好的镇痛效果，但尚未与解剖标志技术进行比较。
目前，在当代文献中，没有足够的证据可以定义超声引导与传统神经定位技术在介入性急性疼痛管理中对急性疼痛及相关结果的影响。
