Department of Anesthesiology, College of Medicine, Mayo Clinic, 200 First Street, S.W., Rochester, MN 55905, USA.
Br J Anaesth. 2013 Apr;110(4):518-28. doi: 10.1093/bja/aet013. Epub 2013 Feb 24.
The objective of this systematic review with meta-analysis was to determine the risk for falls after major orthopaedic surgery with peripheral nerve blockade. Electronic databases from inception through January 2012 were searched. Eligible studies evaluated falls after peripheral nerve blockade in adult patients undergoing major lower extremity orthopaedic surgery. Independent reviewers working in duplicate extracted study characteristics, validity, and outcomes data. The Peto odds ratio (OR) with 95% confidence intervals (CIs) were estimated from each study that compared continuous lumbar plexus blockade with non-continuous blockade or no blockade using a fixed effects model. Ten studies (4014 patients) evaluated the number of falls as an outcome. Five studies did not contain comparison groups. The meta-analysis of five studies [four randomized controlled trials (RCTs) and one cohort] compared continuous lumbar plexus blockade (631 patients) with non-continuous blockade or no blockade (964 patients). Fourteen falls occurred in the continuous lumbar plexus block group when compared with five falls within the non-continuous block or no block group (attributable risk 1.7%; number needed to harm 59). Continuous lumbar plexus blockade was associated with a statistically significant increase in the risk for falls [Peto OR 3.85; 95% CI (1.52, 9.72); P=0.005; I(2)=0%]. Evidence was low (cohort) to high (RCTs) quality. Continuous lumbar plexus blockade in adult patients undergoing major lower extremity orthopaedic surgery increases the risk for postoperative falls compared with non-continuous blockade or no blockade. However, attributable risk was not outside the expected probability of postoperative falls after orthopaedic surgery.
本系统评价和荟萃分析的目的是确定外周神经阻滞下进行主要骨科手术后跌倒的风险。通过 2012 年 1 月的电子数据库进行搜索。符合条件的研究评估了成人患者在接受大下肢骨科手术后接受外周神经阻滞后跌倒的情况。独立审查员以重复的方式提取研究特征、有效性和结果数据。使用固定效应模型，从比较连续腰丛阻滞与非连续阻滞或无阻滞的每项研究中估计 Peto 优势比（OR）及其 95％置信区间（CI）。有十项研究（4014 名患者）评估了跌倒的次数作为结局。五项研究没有对照组。五项研究的荟萃分析[四项随机对照试验（RCT）和一项队列研究]比较了连续腰丛阻滞（631 名患者）与非连续阻滞或无阻滞（964 名患者）。与非连续阻滞或无阻滞组的五例跌倒相比，连续腰丛阻滞组发生了 14 例跌倒（归因风险 1.7％；需要伤害的数量为 59）。连续腰丛阻滞与跌倒风险的统计学显著增加相关[Peto OR 3.85；95％CI（1.52，9.72）；P=0.005；I(2)=0%]。证据质量为低（队列）到高（RCT）。与非连续阻滞或无阻滞相比，成人患者在接受大下肢骨科手术后连续腰丛阻滞会增加术后跌倒的风险。然而，归因风险并未超出骨科手术后术后跌倒的预期概率。
