Huang Wei, Wang Wenyan, Xie Weidang, Chen Zhongqing, Liu Yanan
Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China; The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China.
Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
J Clin Anesth. 2020 Nov;66:109900. doi: 10.1016/j.jclinane.2020.109900. Epub 2020 Jun 2.
The erector spinae plane block (ESPB) is a newly defined regional anesthesia technique first introduced in 2016. The aim of this study is to determine its analgesic efficacy compared with non-block care and thoracic paravertebral block (TPVB).
We systematically searched PubMed, Web of Science citation index, Embase, the Cochrane Library, Google Scholar, and ClinicalTrials.gov register searched up to March 2020. We conducted a meta-analysis of randomized controlled trials (RCTs) that compared an ESPB to non-block care or TPVB for postoperative analgesia in breast and thoracic surgery patients. Primary outcome was 24-hour postoperative opioid consumption. Risk of bias was assessed using Cochrane methodology.
14 RCTs that comprised 1018 patients were included. Seven trials involved thoracic surgery patients and seven included breast surgery patients. Meta-analysis revealed that ESPB significantly reduced 24-hour opioid consumption compared with the non-block groups (-10.5 mg; 95% CI: -16.49 to -3.81; p = 0.002; I = 99%). Similarly, the finding was consistent in subgroup analysis between the breast surgery (-7.75 mg; 95%CI -13.98 to -1.51; p = 0.01; I = 97%) and thoracic surgery (-14.81 mg; 95%CI -21.18 to -8.44; p < 0.001; I = 96%) subgroups. The ESPB significantly reduced pain scores at rest or movement at various time points postoperatively compared with non-block group, and reduced the rate of postoperative nausea and vomiting (OR 0.48; 95%CI 0.27 to 0.86; p = 0.01; I = 0%). In contrast, there were no significative differences reported in any of the outcomes for ESPB versus TPVB strata.
ESPB improved analgesic efficacy in breast and thoracic surgery patients compared with non-block care. Furthermore, current literature supported the ESPB offered comparable analgesic efficacy to a TPVB.
竖脊肌平面阻滞（ESPB）是2016年首次引入的一种新定义的区域麻醉技术。本研究的目的是确定其与非阻滞护理及胸椎旁神经阻滞（TPVB）相比的镇痛效果。
我们系统检索了截至2020年3月的PubMed、科学引文索引数据库、Embase、Cochrane图书馆、谷歌学术以及ClinicalTrials.gov注册库。我们对随机对照试验（RCT）进行了荟萃分析，这些试验比较了ESPB与非阻滞护理或TPVB用于乳房和胸外科手术患者术后镇痛的效果。主要结局是术后24小时的阿片类药物消耗量。使用Cochrane方法评估偏倚风险。
纳入了14项包含1018例患者的RCT。7项试验涉及胸外科手术患者，7项涉及乳房手术患者。荟萃分析显示，与非阻滞组相比，ESPB显著降低了24小时阿片类药物消耗量（-10.5毫克；95%置信区间：-16.49至-3.81；p = 0.002；I² = 99%）。同样，在乳房手术（-7.75毫克；95%置信区间-13.98至-1.51；p = 0.01；I² = 97%）和胸外科手术（-14.81毫克；95%置信区间-21.18至-8.44；p < 0.001；I² = 96%）亚组中的亚组分析结果一致。与非阻滞组相比，ESPB在术后不同时间点显著降低了静息或活动时的疼痛评分，并降低了术后恶心和呕吐的发生率（比值比0.48；95%置信区间0.27至0.86；p = 0.01；I² = 0%）。相比之下，在ESPB与TPVB分层的任何结局中均未报告有显著差异。
与非阻滞护理相比，ESPB提高了乳房和胸外科手术患者的镇痛效果。此外，当前文献支持ESPB与TPVB具有相当的镇痛效果。
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