Department of Anaesthesiology, University Hospital Heidelberg, Heidelberg, Germany.
Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
Br J Anaesth. 2015 May;114(5):728-45. doi: 10.1093/bja/aeu559. Epub 2015 Feb 17.
Our aim was to review the recent evidence for the efficacy of peripheral regional anaesthesia.
Following a systematic literature search and selection of publications based on prospectively agreed upon criteria, we produced a narrative review of the most commonly performed peripheral regional anaesthetic blocks for surgery on the upper limb, the lower limb, and the trunk. We considered short-term and longer-term benefits and complications among the outcomes of interest.
Where good quality evidence exists, the great majority of the blocks reviewed were associated with one or any combination of reduced postoperative pain, reduced opioid consumption, or increased patient satisfaction. For selected surgical procedures, the use of blocks avoided general anaesthesia and was associated with increased efficiency of the surgical pathway. The exceptions were supraclavicular block, where there was insufficient evidence, and transversus abdominis plane block, where the evidence for efficacy was conflicting. The evidence for the impact of the blocks on longer-term outcomes was, in general, inadequate to inform clinical decision making. Permanent complications are rare.
The majority of peripheral regional anaesthetic techniques have been shown to produce benefits for patients and hospital efficiency. Further interventional trials are required to clarify such benefits for supraclavicular block and transversus abdominis plane block and to ascertain any longer-term benefits for almost all of the blocks reviewed. Permanent complications of peripheral regional anaesthetic blocks are rare but accurate estimates of their incidence are yet to be determined.
我们旨在回顾外周区域麻醉有效性的最新证据。
在进行系统的文献检索并根据预先商定的标准选择出版物后，我们对上肢、下肢和躯干手术中最常进行的外周区域麻醉阻滞进行了叙述性综述。我们考虑了感兴趣的结果中的短期和长期益处以及并发症。
在存在高质量证据的情况下，所审查的绝大多数阻滞都与术后疼痛减轻、阿片类药物消耗减少或患者满意度提高有关。对于某些手术程序，使用阻滞可以避免全身麻醉，并与手术途径的效率提高有关。例外情况是锁骨上阻滞，因为证据不足，而腹横筋膜平面阻滞的有效性证据存在冲突。关于阻滞对长期结果影响的证据总体上不足以为临床决策提供信息。永久性并发症很少见。
大多数外周区域麻醉技术已被证明对患者和医院效率有益。需要进一步的干预性试验来阐明锁骨上阻滞和腹横筋膜平面阻滞的这些益处，并确定几乎所有审查的阻滞的任何长期益处。外周区域麻醉阻滞的永久性并发症很少见，但尚未确定其发生率的准确估计。
