Hussain Nasir, Goldar Ghazaleh, Ragina Neli, Banfield Laura, Laffey John G, Abdallah Faraj W
From the Central Michigan University College of Medicine, Mt. Pleasant, Michigan (N.H., G.G., N.R.); Department of Clinical Epidemiology, McMaster University, Hamilton, Ontario, Canada (L.B.); Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada (J.G.L., F.W.A.); Department of Anesthesia and Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada (J.G.L., F.W.A.); Department of Anesthesia, School of Medicine, National University of Ireland, Galway, Ireland (J.G.L.); and Department of Anesthesiology and Pain Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (F.W.A.).
Anesthesiology. 2017 Dec;127(6):998-1013. doi: 10.1097/ALN.0000000000001894.
Interscalene block provides optimal shoulder surgery analgesia, but concerns over its associated risks have prompted the search for alternatives. Suprascapular block was recently proposed as an interscalene block alternative, but evidence of its comparative analgesic effect is conflicting. This meta-analysis compares the analgesic effect and safety of suprascapular block versus interscalene block for shoulder surgery.
Databases were searched for randomized trials comparing interscalene block with suprascapular block for shoulder surgery. Postoperative 24-h cumulative oral morphine consumption and the difference in the area under curve for pooled rest pain scores were designated as primary outcomes. Analgesic and safety outcomes, particularly block-related and respiratory complications, were evaluated as secondary outcomes. Results were pooled using random-effects modeling.
Data from 16 studies (1,152 patients) were analyzed. Interscalene block and suprascapular block were not different in 24-h morphine consumption. The difference in area under the curve of pain scores for the 24-h interval favored interscalene block by 1.1 cm/h, but this difference was not clinically important. Compared with suprascapular block, interscalene block reduced postoperative pain but not opioid consumption during recovery room stay by a weighted mean difference (95% CI) of 1.5 cm (0.6 to 2.5 cm; P < 0.0001). Pain scores were not different at any other time. In contrast, suprascapular block reduced the odds of block-related and respiratory complications.
This review suggests that there are no clinically meaningful analgesic differences between suprascapular block and interscalene block except for interscalene block providing better pain control during recovery room stay; however, suprascapular block has fewer side effects. These findings suggest that suprascapular block may be considered an effective and safe interscalene block alternative for shoulder surgery.
肌间沟阻滞可提供最佳的肩部手术镇痛效果，但对其相关风险的担忧促使人们寻找替代方法。肩胛上神经阻滞最近被提议作为肌间沟阻滞的替代方法，但其相对镇痛效果的证据存在矛盾。本荟萃分析比较了肩胛上神经阻滞与肌间沟阻滞用于肩部手术的镇痛效果和安全性。
检索数据库，查找比较肌间沟阻滞与肩胛上神经阻滞用于肩部手术的随机试验。术后24小时累积口服吗啡用量以及静息疼痛评分汇总曲线下面积的差异被指定为主要结局。镇痛和安全性结局，特别是与阻滞相关的并发症和呼吸并发症，被评估为次要结局。采用随机效应模型汇总结果。
分析了16项研究（1152例患者）的数据。肌间沟阻滞和肩胛上神经阻滞在24小时吗啡用量方面无差异。24小时期间疼痛评分曲线下面积的差异显示肌间沟阻滞更有利，相差1.1 cm/h，但这种差异在临床上并不重要。与肩胛上神经阻滞相比，肌间沟阻滞可减轻术后疼痛，但在恢复室停留期间的阿片类药物用量并未减少，加权平均差（95%CI）为1.5 cm（0.6至2.5 cm；P<0.0001）。其他任何时间的疼痛评分均无差异。相比之下，肩胛上神经阻滞降低了与阻滞相关的并发症和呼吸并发症的发生率。
本综述表明，肩胛上神经阻滞和肌间沟阻滞在镇痛方面没有临床意义上的差异，除了肌间沟阻滞在恢复室停留期间能更好地控制疼痛；然而，肩胛上神经阻滞的副作用更少。这些发现表明，肩胛上神经阻滞可被视为肩部手术中一种有效且安全的肌间沟阻滞替代方法。
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