McIsaac D I, Cole E T, McCartney C J L
Department of Anesthesiology, University of Ottawa, Ottawa, Ontario, Canada Department of Anesthesiology, The Ottawa Hospital, Ottawa, Ontario, Canada Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Department of Anesthesiology, University of Ottawa, Ottawa, Ontario, Canada.
Br J Anaesth. 2015 Dec;115 Suppl 2:ii46-56. doi: 10.1093/bja/aev376.
Regional anaesthesia (RA) is often included in enhanced recovery protocols (ERPs) as an important component of a bundle of interventions to improve outcomes after surgery. We sought to delineate whether the literature supports the use of RA in this setting with regard to commonly measured outcomes. We further sought to assess whether such improvements would translate into positive impacts on healthcare value as defined by the Institute for Healthcare Improvement Triple Aim. We conducted a scoping review to address our objectives. Studies of ERPs that included RA and reported at least one outcome of interest in comparison to a control group were included. MEDLINE, EMBASE, CENTRAL, CDSR, PROSPERO, and the NHS Economic Evaluation Database were searched up to May 2015. Two reviewers assessed studies and extracted data. Of 695 identified citations, 58 studies were included for analysis. The majority (53%) were in colorectal surgery. Positive impacts of RA on all outcomes were identified; however, value-based outcomes were rarely reported. Where value-based outcomes were reported, RA appears to have a positive impact on global measures of health and function and on economic outcomes. Existing literature supports a positive impact of RA on ERP outcomes, which may be reflected in improved healthcare value. In order to justify the value of RA in ERPs, a future focus on appropriate measures is needed to align research with widely accepted frameworks, such as the Triple Aim.
区域麻醉（RA）通常作为一系列改善术后结局的干预措施的重要组成部分被纳入强化康复方案（ERP）中。我们试图确定文献是否支持在这种情况下使用RA来实现常见的测量结局。我们还试图评估这些改善是否会转化为对医疗保健价值的积极影响，如医疗保健改善研究所的三重目标所定义的那样。我们进行了一项范围综述以实现我们的目标。纳入了关于ERP且将包含RA的情况与对照组进行比较并报告了至少一项感兴趣结局的研究。检索了截至2015年5月的MEDLINE、EMBASE、CENTRAL、CDSR、PROSPERO和英国国家医疗服务体系经济评估数据库。两名评审员评估研究并提取数据。在695条识别出的文献中，有58项研究被纳入分析。大多数（53%）是关于结直肠手术的。确定了RA对所有结局都有积极影响；然而，基于价值的结局很少被报告。在报告了基于价值的结局的情况下，RA似乎对整体健康和功能指标以及经济结局有积极影响。现有文献支持RA对ERP结局有积极影响，这可能体现在改善医疗保健价值上。为了证明RA在ERP中的价值，未来需要关注适当的测量指标，使研究与广泛接受的框架（如三重目标）保持一致。
