Guy's and St Thomas' NHS Foundation Trust, London, UK.
Northwick Park Hospital, Harrow, UK.
Clin Otolaryngol. 2018 Oct;43(5):1201-1208. doi: 10.1111/coa.13128. Epub 2018 Jun 5.
The aim of the study was to perform a systematic review of existing evidence on the role of local anaesthetic nerve block (LAB) in patients undergoing endoscopic sinus surgery (ESS).
The databases searched were the Cochrane Register of Controlled Trials, MEDLINE and Embase using the Ovid portal (1946-2017).
Seven randomised controlled trials were included. Due to considerable heterogeneity of data, only two studies were pooled into meta-analysis which demonstrated a statistically significantly better surgical field quality during ESS in the LAB group compared with the control group (MD -0.86; 95% CI -2.24, 0.51; P = .009). No adverse events related to LAB toxicity were reported.
Sphenopalatine ganglion LAB with adrenaline carries relatively low risk of morbidity, but may improve the quality of the surgical field in terms of bleeding. However, there are limitations of the study due to heterogeneity of methods, quality and size of the studies. Well-conducted large RCTs are needed using standardised inclusion criteria, balanced baseline characteristics of cohorts, and validated subjective and objective outcome measures.
本研究旨在对现有关于局部麻醉神经阻滞（LAB）在接受鼻内镜鼻窦手术（ESS）患者中的作用的证据进行系统评价。
使用 Ovid 门户（1946-2017 年）在 Cochrane 对照试验注册库、MEDLINE 和 Embase 数据库中进行检索。
纳入了 7 项随机对照试验。由于数据存在较大异质性，仅对两项研究进行了荟萃分析，结果显示 LAB 组在 ESS 过程中的手术视野质量明显优于对照组（MD -0.86；95%CI -2.24，0.51；P = 0.009）。未报告与 LAB 毒性相关的不良事件。
使用肾上腺素的蝶腭神经节 LAB 具有相对较低的发病率风险，但可能会改善手术视野的出血情况。然而，由于研究方法、质量和规模的异质性，研究存在局限性。需要进行精心设计的大型 RCT，使用标准化的纳入标准、队列基线特征的平衡以及经过验证的主观和客观的结果评估措施。
