Grape Sina, El-Boghdadly Kariem, Albrecht Eric
Department of Anaesthesia, Valais Hospital, 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;63:109745. doi: 10.1016/j.jclinane.2020.109745. Epub 2020 Feb 26.
Due to conflicting results published in the literature regarding the analgesic superiority between the paravertebral block and the PECS block, the study objective is to determine which one should be the first line analgesic treatment after radical mastectomy.
Systematic review, meta-analysis and trial sequential analysis.
Operating room, postoperative recovery area and ward, up to 24 postoperative hours.
Patients scheduled for radical mastectomy under general anaesthesia.
We searched five electronic databases for randomized controlled trials comparing any PECS block with a paravertebral block.
The primary outcome was rest pain score (0-10) at 2 postoperative hours, analyzed according to the combination with axillary dissection or not, to account for heterogeneity. Secondary outcomes included rest pain scores, cumulative intravenous morphine equivalents consumption and rate of postoperative nausea and vomiting at 24 postoperative hours.
Eight trials including 388 patients were identified. Rest pain scores at 2 postoperative hours were decreased in the PECS block group, with a mean difference (95%CI) of -0.4 (-0.7 to -0.1), I = 68%, p = 0.01, and a significant subgroup difference observed between radical mastectomy with (mean difference [95%CI]: 0.0 [-0.2 to 0.2], I = 0%, p = 1.00), or without axillary dissection (mean difference [95%CI]: -0.7 [-1.1 to -0.4], I = 40%, p < 0.001; p for subgroup difference < 0.001). All secondary pain-related outcomes were similar between groups. The overall quality of evidence was low.
There is low quality evidence that a PECS block provides marginal postoperative analgesic benefit after radical mastectomy at 2 postoperative hours only, when compared with a paravertebral block, and not beyond. Clinical trial number: PROSPERO - registration number: CRD42019131555.
由于文献中关于椎旁阻滞和胸肌下神经血管束阻滞（PECS阻滞）之间镇痛优势的结果相互矛盾，本研究的目的是确定哪一种应作为根治性乳房切除术后的一线镇痛治疗方法。
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。
计划在全身麻醉下进行根治性乳房切除术的患者。
我们检索了五个电子数据库，以查找比较任何PECS阻滞与椎旁阻滞的随机对照试验。
主要结局是术后2小时的静息疼痛评分（0-10分），根据是否合并腋窝淋巴结清扫进行分析，以考虑异质性。次要结局包括术后24小时的静息疼痛评分、静脉注射吗啡等效物的累积消耗量以及术后恶心呕吐发生率。
共纳入8项试验，388例患者。PECS阻滞组术后2小时的静息疼痛评分降低，平均差值（95%CI）为-0.4（-0.7至-0.1），I²=68%，p=0.01，在合并腋窝淋巴结清扫的根治性乳房切除术（平均差值[95%CI]：0.0[-0.2至0.2]，I²=0%，p=1.00）或未合并腋窝淋巴结清扫的根治性乳房切除术中观察到显著的亚组差异（平均差值[95%CI]：-0.7[-1.1至-0.4]，I²=40%，p<0.001；亚组差异p<0.001）。两组之间所有次要的疼痛相关结局相似。证据的总体质量较低。
与椎旁阻滞相比，低质量证据表明PECS阻滞仅在术后2小时为根治性乳房切除术后提供了边际性的术后镇痛益处，超过此时则无。临床试验编号：PROSPERO-注册号：CRD42019131555。
