Grape Sina, Jaunin Eric, El-Boghdadly Kariem, Chan Vincent, Albrecht Eric
Department of Anaesthesia, Valais Hospital, Sion, Switzerland.
Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; King's College London, London, United Kingdom.
J Clin Anesth. 2020 Aug;63:109744. doi: 10.1016/j.jclinane.2020.109744. Epub 2020 Feb 25.
To determine whether pectoral nerves (PECS) blocks provide effective postoperative analgesia when compared with no regional technique in patients undergoing breast surgery.
Systematic review, meta-analysis and trial sequential analysis.
Operating room, postoperative recovery area and ward, up to 24 postoperative hours.
Patients undergoing breast surgery under general anaesthesia with either PECS block or no regional technique.
We searched five electronic databases for randomized controlled trials comparing PECS block with no block or sham injection.
The primary outcome was rest pain scores (analogue scale, 0-10) at 2 h, analysed according to surgery (mastectomy vs other breast surgery) and regional technique (PECS 2 vs other blocks), among others. Secondary outcomes included morphine equivalent consumption, and rate of postoperative nausea and vomiting at 24 h.
Sixteen trials including 1026 patients were identified. Rest pain scores at 2 h were decreased in the PECS blocks group, with a mean (95%CI) difference of -1.5 (-2.0, -1.0); I2 = 93%; p < 0.001, with no differences between surgery (mastectomy, mean difference [95%CI]: -1.8 [-2.4, -1.2], I = 91%, p < 0.001; other breast surgery, mean difference [95%CI]: -1.1 [-2.1, -0.1], I = 94%, p = 0.03; p for subgroup difference = 0.25), and regional technique (PECS 2, mean differences [95%CI]: -1.6 [-2.3, -1.0], I = 94%, p < 0.001; other blocks, mean differences [95%CI]: -1.3 [-2.4, -0.1], I = 74%, p = 0.04; p for subgroup difference = 0.57). The rate of postoperative nausea and vomiting was reduced from 30.8% (95%CI: 25.7%, 36.3%) to 18.7% (95%CI, 14.4%, 23.5%; p = 0.01). Similarly, secondary outcomes were significantly improved in the PECS blocks group. The overall quality of evidence was moderate-to-high.
There is moderate-to-high level evidence that PECS blocks provide postoperative analgesia after breast surgery when compared with no regional technique and reduce rate of PONV. This might provide the most benefit to those at high-risk of postoperative pain.
确定与未采用区域技术的患者相比，胸神经（PECS）阻滞能否为接受乳房手术的患者提供有效的术后镇痛。
系统评价、荟萃分析和试验序贯分析。
手术室、术后恢复区和病房，术后24小时内。
接受全身麻醉下乳房手术且采用PECS阻滞或未采用区域技术的患者。
我们检索了五个电子数据库，以查找比较PECS阻滞与未阻滞或假注射的随机对照试验。
主要结局是术后2小时的静息疼痛评分（视觉模拟量表，0 - 10分），根据手术类型（乳房切除术与其他乳房手术）和区域技术（PECS 2与其他阻滞）等进行分析。次要结局包括吗啡等效剂量消耗量以及术后24小时的恶心呕吐发生率。
共纳入16项试验，涉及1026例患者。PECS阻滞组术后2小时的静息疼痛评分降低，平均（95%CI）差值为 -1.5（-2.0，-1.0）；I² = 93%；p < 0.001，手术类型（乳房切除术，平均差值[95%CI]：-1.8 [-2.4，-1.2]，I = 91%，p < 0.001；其他乳房手术，平均差值[95%CI]：-1.1 [-2.1，-0.1]，I = 94%，p = 0.03；亚组差异p = 0.25）和区域技术（PECS 2，平均差值[95%CI]：-1.6 [-2.3，-1.0]，I = 94%，p < 0.001；其他阻滞，平均差值[95%CI]：-1.3 [-2.4，-0.1]，I = 74%，p = 0.04；亚组差异p = 0.57）之间均无差异。术后恶心呕吐发生率从30.8%（95%CI：25.7%，36.3%）降至18.7%（95%CI，14.4%，23.5%；p = 0.01）。同样，PECS阻滞组的次要结局也有显著改善。证据的总体质量为中到高。
有中到高水平的证据表明，与未采用区域技术相比，PECS阻滞可为乳房手术后患者提供术后镇痛，并降低恶心呕吐发生率。这可能对术后疼痛高危患者最有益。
