Department of Anaesthesiology, Singapore General Hospital, Singapore.
Central Library, National University of Singapore.
Anaesthesia. 2021 Mar;76(3):404-413. doi: 10.1111/anae.15164. Epub 2020 Jul 1.
The erector spinae plane block is a new regional anaesthesia technique that provides truncal anaesthesia for breast surgery. This systematic review and meta-analysis was undertaken to determine if the erector spinae plane block is effective at reducing pain scores and opioid consumption after breast surgery. This study also evaluated the outcomes of erector spinae plane blocks compared with other regional blocks. PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov were searched. We included randomised controlled trials reporting the use of the erector spinae plane block in adult breast surgery. Risk of bias was assessed with the revised Cochrane risk-of-bias tool. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was used to assess trial quality. Thirteen randomised controlled trials (861 patients; 418 erector spinae plane block, 215 no blocks, 228 other blocks) were included. Erector spinae plane block reduced postoperative pain compared with no block: at 0-2 hours (mean difference (95% CI) -1.63 (-2.97 to -0.29), 6 studies, 329 patients, high-quality evidence, I = 98%, p = 0.02); at 6 hours (mean difference (95% CI) -0.90 (-1.49 to -0.30), 5 studies, 250 patients, high-quality evidence, I = 91%, p = 0.003); at 12 hours (mean difference (95% CI) -0.46 (-0.67 to -0.25), 5 studies, 250 patients, high-quality evidence, I = 58%, p < 0.0001); and at 24 hours (mean difference (95% CI) -0.50 (-0.70 to -0.30), 6 studies, 329 patients, high-quality evidence, I = 76%, p < 0.00001). Compared with no block, erector spinae plane block also showed significantly lower postoperative oral morphine equivalent requirements (mean difference (95% CI) -21.55mg (-32.57 to -10.52), 7 studies, 429 patients, high-quality evidence, I = 99%, p = 0.0001). Separate analysis of studies comparing erector spinae plane block with pectoralis nerve block and paravertebral block showed that its analgesic efficacy was inferior to pectoralis nerve block and similar to paravertebral block. The incidence of pneumothorax was 2.6% in the paravertebral block group; there were no reports of complications of the other blocks. This review has shown that the erector spinae plane block is more effective at reducing postoperative opioid consumption and pain scores up to 24 hours compared with general anaesthesia alone. However, it was inferior to the pectoralis nerve block and its efficacy was similar to paravertebral block. Further evidence, preferably from properly blinded trials, is required to confirm these findings.
竖脊肌平面阻滞是一种新的区域麻醉技术，可为乳房手术提供躯干麻醉。本系统评价和荟萃分析旨在确定竖脊肌平面阻滞是否能有效降低乳房手术后的疼痛评分和阿片类药物的使用量。本研究还评估了竖脊肌平面阻滞与其他区域阻滞的结果。检索了 PubMed、Embase、Scopus、Cochrane 中心对照试验注册库和 ClinicalTrials.gov。我们纳入了报告在成人乳房手术中使用竖脊肌平面阻滞的随机对照试验。使用修订后的 Cochrane 偏倚风险工具评估偏倚风险。使用 Grading of Recommendations, Assessment, Development and Evaluation (GRADE) 框架评估试验质量。纳入了 13 项随机对照试验（861 例患者；418 例竖脊肌平面阻滞，215 例无阻滞，228 例其他阻滞）。与无阻滞相比，竖脊肌平面阻滞可降低术后疼痛：0-2 小时（平均差值（95%CI）-1.63（-2.97 至-0.29），6 项研究，329 例患者，高质量证据，I²=98%，p=0.02）；6 小时（平均差值（95%CI）-0.90（-1.49 至-0.30），5 项研究，250 例患者，高质量证据，I²=91%，p=0.003）；12 小时（平均差值（95%CI）-0.46（-0.67 至-0.25），5 项研究，250 例患者，高质量证据，I²=58%，p<0.0001）；24 小时（平均差值（95%CI）-0.50（-0.70 至-0.30），6 项研究，329 例患者，高质量证据，I²=76%，p<0.00001）。与无阻滞相比，竖脊肌平面阻滞还显示术后口服吗啡等效物需求显著降低（平均差值（95%CI）-21.55mg（-32.57 至-10.52），7 项研究，429 例患者，高质量证据，I²=99%，p=0.0001）。对比较竖脊肌平面阻滞与胸大肌神经阻滞和椎旁阻滞的研究进行单独分析显示，其镇痛效果不如胸大肌神经阻滞，与椎旁阻滞相似。椎旁阻滞组气胸发生率为 2.6%；其他阻滞无并发症报告。本综述表明，与单纯全身麻醉相比，竖脊肌平面阻滞在降低术后阿片类药物使用量和疼痛评分方面更有效，长达 24 小时。然而，它不如胸大肌神经阻滞有效，其效果与椎旁阻滞相似。需要进一步的证据，最好是来自适当盲法的试验，以证实这些发现。
