Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada.
Korean J Anesthesiol. 2021 Oct;74(5):394-408. doi: 10.4097/kja.20304. Epub 2020 Sep 23.
Continuous peripheral nerve blocks (CPNBs) have been investigated to control pain for abdominal surgery via midline laparotomy while avoiding the adverse events of opioid or epidural analgesia. The review compiles the evidence comparing CPNBs to multimodal and epidural analgesia.
We conducted a systematic review using broad search terms in MEDLINE, EMBASE, Cochrane. Primary outcomes were pain scores and cumulative opioid consumption at 48 hours. Secondary outcomes were length of stay and postoperative nausea and vomiting (PONV). We rated the quality of the evidence using Cochrane and GRADE recommendations. The results were synthesized by meta-analysis using Revman.
Our final selection included 26 studies (1,646 patients). There was no statistically significant difference in pain control comparing CPNBs to either multimodal or epidural analgesia (low quality evidence). Less opioids were consumed when receiving epidural analgesia than CPNBs (mean difference [MD]: -16.13, 95% CI [-32.36, 0.10]), low quality evidence) and less when receiving CPNBs than multimodal analgesia (MD: -31.52, 95% CI [-42.81, -20.22], low quality evidence). The length of hospital stay was shorter when receiving epidural analgesia than CPNBs (MD: -0.78 days, 95% CI [-1.29, -0.27], low quality evidence) and shorter when receiving CPNBs than multimodal analgesia (MD: -1.41 days, 95% CI [-2.45, -0.36], low quality evidence). There was no statistically significant difference in PONV comparing CPNBs to multimodal (high quality evidence) or epidural analgesia (moderate quality evidence).
CPNBs should be considered a viable alternative to epidural analgesia when contraindications to epidural placement exist for patients undergoing midline laparotomies.
连续外周神经阻滞（CPNB）已被研究用于通过中线剖腹术控制腹部手术的疼痛，同时避免阿片类药物或硬膜外镇痛的不良反应。本综述汇总了 CPNB 与多模式和硬膜外镇痛比较的证据。
我们使用 MEDLINE、EMBASE 和 Cochrane 中的广泛搜索词进行了系统综述。主要结局是 48 小时时的疼痛评分和累积阿片类药物消耗量。次要结局是住院时间和术后恶心和呕吐（PONV）。我们使用 Cochrane 和 GRADE 建议评估证据质量。结果通过 Revman 进行荟萃分析进行综合。
我们的最终选择包括 26 项研究（1646 名患者）。CPNB 与多模式或硬膜外镇痛相比，在疼痛控制方面没有统计学上的显著差异（低质量证据）。接受硬膜外镇痛时消耗的阿片类药物少于 CPNB（平均差异[MD]：-16.13，95%置信区间[-32.36，0.10]），低质量证据），而接受 CPNB 时则少于多模式镇痛（MD：-31.52，95%置信区间[-42.81，-20.22]）。接受硬膜外镇痛时的住院时间短于 CPNB（MD：-0.78 天，95%置信区间[-1.29，-0.27]），接受 CPNB 时短于多模式镇痛（MD：-1.41 天，95%置信区间[-2.45，-0.36]）。CPNB 与多模式（高质量证据）或硬膜外镇痛（中等质量证据）相比，PONV 无统计学差异。
当中线剖腹术患者存在硬膜外置管禁忌时，CPNB 应被视为硬膜外镇痛的可行替代方案。
